ARDS with septic shock managed successfully using a multidisciplinary approach: A case report

Acute respiratory distress syndrome (ARDS) is an inflammatory process in the lungs that results in hypoxemia and decreased lung compliance. Invasive mechanical ventilation and prone positioning have proven benefits in the management of patients with severe ARDS. Post-extubation rehabilitation programs are equally important for the recovery of these patients. We are reporting the case of a 30-year-old male with severe ARDS where lung protective ventilation, timely intubation, early prone positioning, multidisciplinary communication, and post-discharge follow-up with teleconsultation were used under expert supervision in the successful management of the case

Psychological trauma and depression in recovered COVID-19 patients: a telecommunication based observational study

Abstract Introduction Coronavirus disease 2019 (COVID-19) is adversely affecting the mental health of patients infected with the virus and the psychological impact on recovered COVID-19 patients is unclear. Objectives The study aimed to assess posttraumatic stress disorder (PTSD) and depression among COVID-19 patients after recovery from the disease. Methods This cross-sectional study was conducted from November 9, 2020, to December 23, 2020. The study used a telemedicine model to enroll recovered COVID-19 patients from a database of patients provided by the health authorities. The National Stressful Events Survey PTSD Short Scale (NSESSS) for adults was used to assess PTSD symptoms and the Patient Health Questionnaire (PHQ-9) was used to assess depression. Results The study enrolled 503 recovered COVID-19 patients with a mean age of 41.90 years. The majority were asymptomatic (64.6%), while 21.5% had had moderate to severe forms of the disease. Prevalence rates of PTSD symptoms and depression were 56.9 and 29% respectively. COVID-19 patients with severe forms of the disease were significantly more affected by PTSD symptoms (vs. mild, odds ratio [OR] = 18.7, 95%confidence interval [CI] 9.9-35.5) and depression (vs. mild, OR = 19.8, 95% CI 9.9-39.5). Similarly, patients who required oxygen or ventilator support reported significantly higher rates of PTSD symptoms (vs. managed at home, OR = 17.4, 95% CI 8.3-36.4) and depression (vs. managed at home, OR = 22.0, 95% CI 10.1-47.7). Conclusion This study reports that recovered COVID-19 patients suffered from a significant amount of depression and experienced significant PTSD symptoms. It will help with addressing a major psychological concern among the recovered subjects.

Phylogenetic Variation of Muscle Flexor Digitorum Brevis- Rare Variation on the Right Foot.

Background: Flexor digitorum breves is an intrinsic muscle of the sole of the foot that lies superior to the central part of planter apponurosis and inferior to the tendons of flexor digitorum longus. This flat spindle shaped muscle arise from the medial process of tuber calcanei, proximal part of planter apponurosis, inter muscular septa and adjacent fascial layers. The muscle fiber conver anteriorly forming four tendons one each for the four lateral toes at the bases of proximal phalenges each tendon splits into two slips around the tendon of flexor digitorum longus, reunites into a chiasma, devides again to insert into margins of intermediate phalenges of lateral four toes. Methods: This study was carried out by routine dissection classes for undergraduate medical students classes from July 2010 to January 2014 in the department of anatomy, Teerthanker Mahaveer medical college Moradabad; department of anatomy, Rama medical college Kanpur; Department of Anatomy, Hamdard Institute of Medical Science & Research, Jamia Hamdard New Delhi. Total no. of 80 cadavers (48 male and 32 female) all the cadavers were been preserved in 10% of formalin and age ranged between 45 to 67 years. Results: Summarising the result indicates out of 80 cadavers 25% were having none anatomical variation, 46% of cadavers had bilateral absence of tendon for fifth toe of flexor digitorum breves while 18% of cadavers having variation on the left foot and rare 9% of cadavers were represented having variation on the right foot while the left foot was anatomically normal. Conclusion: Variation of flexor digitorum breves may occur as phylogenetical changes due to minimal use of little toe in evolved bipedal posture.

Differential Criteria to Evaluate Parasite (Plasmodium) and Bacteria (Salmonella) for Diagnosis of Malaria and Typhoid Fever.

Background: In the investigation of fever, Malaria and Typhoid are major health problems in tropical and subtropical countries. Both cause significant morbidity, mortality and economic loss. The aim of study is to evaluate the prevalence of Malaria and Typhoid. Methods: Five hundred three samples were collected from patients suspected for malaria and typhoid fever. Peripheral blood smears (thick and thin) were used for microscopic examination and also malaria card test used for malaria parasite. For Typhoid, Widal agglutination test and Typhi dot IgG/IgM conducted for the identification of antibodies. Result: The study indicated that out of 503 patients, in which 158 male (69%) followed by 71 female (31%) were found positive. The prevalence rate of infection was 45.52%. Conclusion: The prevalence rate of malaria and typhoid fever was high. Salmonella typhi appears to be the most prevalent species infecting people. In other studies prevalence rate were quite low. Most of the studies should be done on the other determinants of plasmodium, salmonella and their co-infection in different format of diagnosis and case study.

Distribution pattern of HCV genotypes & its association with viral load.

Background & objectives: Hepatitis C virus (HCV) has emerged as a leading cause of chronic hepatitis, liver cirrhosis and hepatocellular carcinoma worldwide. Genotyping and assessment of the viral load in HCV patients is important for designing the therapeutic strategies. Thus the present study was designed to determine the distribution pattern of HCV genotypes in chronic hepatitis patients and their association with the viral load and biochemical profiles. Methods: Seventy one HCV RNA positive patients were included in the study. HCV genotyping was carried out by restriction fragment length polymorphism (RFLP) followed by the direct sequencing of the core region. Viral load estimation was carried out by Taqman real time PCR system. Results: Sixty three per cent (45/71) of cases were infected with genotype 3 followed by genotype 1 in 30.98 per cent (22/71) and genotype 2 in 5.63 per cent (4/71) of cases. Genotype 1 was associated with a significantly (P<0.001) higher viral load as compared to genotypes 3 and 2. There was no significant difference seen in the biochemical profile between the three groups of genotypes except in the levels of SGOT. The commonest mode of transmission was parenteral which accounted for 68 per cent of all the infected cases. Interpretation & conclusions: The present study revealed that HCV genotype 3 and 1 accounted for approximately 95 per cent of the HCV infection in Delhi and surrounding areas. Also two atypical subtypes like 3i and 3f were identified. Genotype 1 was associated with more severity of liver disease as compared to genotypes 3 and 2 as assessed by viral load.

Isolated lacrimal gland involvement in Rosai-Dorfman-Destombes disease.

Rosai-Dorfman-Destombes (sinus histiocytosis with massive lymphadenopathy) disease is an uncommon disease characterized by benign proliferation of histiocytes, with painless lymph node enlargement and frequent extranodal disease. Orbital involvement occurs in 9-11% of cases. However, isolated Rosai-Dorfman-Destombes disease of the lacrimal gland without any systemic involvement is very rare with only three case reports. We describe here one such young male patient with unilateral lacrimal gland swelling. Excision biopsy revealed almost complete replacement of the lacrimal gland by lymphocytes, plasma cells and large pale histiocytes. The latter exhibited emperipolesis and stained positive for S-100 and CD68 on immunohistochemistry. Patient is well and has no other manifestation or recurrence of the disease during a follow-up of 24 months.