Differences in COVID-19 mortality in males and females: Is estrogen hormone attributing to sex differences?

Objectives: Globally, the case fatality ratio is more in males versus females. Some studies have suggested estrogen hormone decreases susceptibility to SARS CoV-2. We have analyzed the observed sex differences in COVID-19 behavior in males and females and the clinical profiles of females of different age groups of COVID-19 patients and discussed their symptoms, laboratory evaluations, and associated comorbidities. Material and Methods: The patients were tested for COVID-19 through real-time RT-PCR (Reverse Transcription Polymerase Chain Reaction) assay. The data obtained were studied for the epidemiological, clinical, and laboratory characteristics from their medical records. Results: The mortality rate in females was 12.33% (36/292) whereas mortality in males was 19.63% (84/428). In between group analysis, 8.7% (14/161) of females died in the <40 years age group versus 16.8% (22/131) in more than 40 years age group whereas in males, the mortality was 13.7% (21/153) in <40 years versus 22.9%(63/275). The mortality rate in women older than 40 years was greater than mortality in younger females emphasizing the protection provided by estrogen hormone in them. The proportion of patients who expired due to COVID-19 significantly differs by age cutoff of 40 years, X2 (1, n = 428). The difference is statistically significant at P < 0.05. Males more than 40 years are more likely to expire. Conclusion: Sex-related differences in coronavirus pandemic have been found pointing toward the protective role of estrogen hormone and other differences in immunological behavior in males and females. Downregulation of ACE2 expression, thereby reducing viral entry, might also be contributory to decreasing mortality in females.

Study of the clinical profile and upper gastrointestinal endoscopic findings in patients with chronic kidney disease

Background: Uremic milieu associated with chronic kidney disease (CKD) is associated with upper gastrointestinal (GI) symptoms such as nausea, vomiting, anorexia, and GI bleeding. Objective: The present study intended to ascertain the prevalence of various upper GI (UGI) symptoms and UGI endoscopic abnormalities in patients of CKD. Materials and Methods: Patients were stratified according to glomerular filtration rate and their respective GI symptoms score was determined and they were subjected to UGI endoscopy. Results: Thirty males and 24 females of CKD were compared with equal number of control group who have normal kidney function but may or may not have UGI disturbance. The severity of CKD correlated with high GI symptom score with maximum number of patients in dialyzed CKD subgroup. Anorexia followed by nausea and abdominal pain was dominant symptoms in the study group. On endoscopic evaluation, hiatus hernia and duodenitis were significantly more prevalent in the study group over the control group. Conclusion: Based on these observations, this study supports the routine usage of UGI endoscopy in evaluation of CKD patients.

The Newly Developed Highly Sensitive Method For The Determination Of Capecitabine By Using Uv-Spectroscopy

Capecitabine is a fluoropyrimidine carbamate, designed as 'pro-drug' to the cytotoxic agent 5-fluorouracil (5-FU) meant to be administered orally. Capecitabine is used as first line monotherapy for metastatic colorectal cancer. In the present study simple, rapid, accurate UV spectrophotometric methods were developed and validated for the estimation of capecitabine in bulk and its formulations as per ICH guidelines. Three solvent systems viz., 0.1N NaOH, 0.1N HCl and Methanol: Water (1:3) were tried. The results suggest that the developed methods shows linearity over the concentration range of 2-24μg/ml with a correlation coefficient of 0.9999. All the developed methods were statistically validated for accuracy, precision, linearity, robustness, and ruggedness as per ICH guidelines. The % RSD values for validated methods were found to be less than 1.5 and methods will find application in routine analysis of drug formulations containing capecitabine.

Myriad manifestations of dengue fever: Analysis in retrospect

Background: Dengue is a viral disease which has grown dramatically over the years and has emerged as a public health issue requiring intervention to curb its spread. Favorable environment, abundance of vector, and lack of hygiene are leading to unprecedented spread of the disease. Objectives: The objectives were to study the prevalence of various manifestations of dengue fever. Materials and Methods: The study was conducted at Sarojini Naidu Medical College, Agra, during the outbreak from August to November 2015. During the study period, we observed a total of 131 patients. The serology included dengue immunoglobulin (Ig)-M, IgG, and non-structural protein 1 antigen. This study is a hospital-based retrospective study. All the data were expressed in percentage. Results: In this study, we found that cutaneous manifestation was seen in 22.9%, bleeding manifestation in 21.37%, polyserositis in 20.61%, fever in all patients 100%, thrombocytopenia platelet count <10,000 in 71.67%, organomegaly in 25.19%, and gallbladder wall thickening in 6.1%. Atypical manifestation such as hepatic coma, acute respiratory distress, seizure, and chest pain (myocarditis) was also seen in some patients. In this study, 62.59% affected patients were young male in the age group of 21 to 50 year thus it showed that dengue is more prevalent in young male population. Conclusion: The problem of dengue is ginormous in our country; the problem is multiplied due to humongous population, poor hygiene, lack of medical and diagnostic facilities, inadequate vector control measures, and lack of awareness among the population. Hence, future studies should be aimed to identify various atypical manifestations as well as early treatment protocols for timely intervention so as to halt the disease progression.

Study of Non-Alcoholic Fatty Liver Disease with Special Reference to Liver Enzyme and Radiological Finding

Background: Non-alcoholic fatty liver disease (NAFLD) is a distinct hepatic condition characterized by abnormal fat accumulation in liver cells; histologically resembling alcohol induced liver damage. The term NAFLD is used to describe a wide array of fatty liver changes from simple steatosis to steatohepatitis, cirrhosis and hepatocellular carcinoma (HCC), in the absence, of excessive alcohol intake. Methods: 312 suspected patients of NAFLD above the age group of 15 and irrespective of sex were screened during the study. Total 60 patients were selected according to the inclusion and exclusion criteria designed for our study. Further clinical (history, BMI, BP,etc.), biochemical (blood sugar profile, lipid profile, serum transaminases, Serum uric acid etc.), histopathological (liver biopsy) and radiological profiling (USG) was done. Result : Our 60 recruited patients had a mean age of 52.53±11.68 years with 21 (35%) male subjects and 39 (65%) female subjects. We found that fatigue, malaise and abdominal pain were the commonest whereas heart burn as the second commonest complain among the study group. Further clinical examination of 26 (43.3%) patients with RUQ abdominal pain revealed that 14 (53.8%) had abdominal tenderness, 10 (38.5%) had abdominal tenderness with hepatomegaly and 2 (7.7%) had no significant clinical findings. Our study revealed mean BMI to be 27±6.32 kg/m2 with more than half of our patients were pre-obese (33.3%) and obese (28.3%). Lipid profiling revealed 13 (21.7%) patients had hypertriglyceridemia. Serum transaminases revealed 22 (36.7%) and 39 (65%) had raised SGPT/ALT and SGOT/AST levels respectively. Ultrasonographically, 30 (50%) had grade-I, 23 (38.3%) had grade-II and 7 (11.7%) had grade-III fatty liver. Due to low patient compliance, only 3 (5%) had their liver biopsy done which revealed steatosis and dense fibrosis. Conclusion: Current absence of specific treatment further for NASH and NAFL emphasizes the need of healthy diet, yoga and daily exercise in order to control insulin resistance/metabolic syndrome.

Echocardiographic Changes in Type 2 Diabetes Mellitus with Reference to Body Mass Index and Waist Hip Ratio

Background: Diabetes mellitus (DM) refers to a group of common metabolic disorders that share the phenotype of hyperglycaemia. India alone had 65.1 million diabetics by the year 2013. DM with high BMI & increased central obesity (WHR) have changes in the cardiac geometry evidenced in echocardiography. AIM OF STUDY: Estimation of Body Mass Index (BMI) and Waist Hip Ratio (WHR) & Establish a relationship between obesity, particularly central obesity in type 2 diabetes mellitus patients and cardiac changes with the help of echocardiography.  Methods: 30 Subjects with type 2 DM attending the OPD or admitted in Katihar Medical College indoor department & 30 control patients were also be taken from the same, all of age >40 years. The cases and the controls were examined thoroughly with respect to BMI (>30) & WHR (> 0.85 for females and > 0.95 for males) and echocardiography was done. Results: The cases i.e. type 2 diabetes with high WHR and BMI had highly significant alteration in LV geometry as compared to the controls & had significantly high mean LV mass 189.10grams as compared to 134.04 grams of the controls. There was significant early diastolic dysfunction found in the cases group while no significant difference was found in systolic dysfunction between cases & controls. The incidence of changes in left ventricular geometry was higher in female type 2 diabetic subjects with high waist hip ratio and BMI as compared to males. Conclusions: Form the data of the present study it can be concluded that type 2 diabetics with obesity, particularly central type, have an increased predisposition to the development of left ventricular structural or geometrical abnormality. They have significantly higher left ventricular Mass. Obese type 2 diabetics also have higher incidence of diastolic dysfunction. All these abnormalities occur with greater frequency in females. Thus, type 2 diabetics with high BMI and Waist hip ratio have higher risk of development of cardiovascular disease, which is higher for female than males.

Evaluation of Hematological Abnormalities in HIV Patients in Kosi Zone of Bihar

Background: Hematological abnormalities are among the most common complications of HIV.  Anaemia is the most common hematological abnormality in HIV patients, and is strongly associated with the progression of the disease, followed by leucopenia and thrombocytopenia. The objective of the study is to find out the magnitude & type of hematological abnormalities and its correlation to CD4 Count.  Methods: The study was done on 80 HIV patients, above the age of 15 yrs, including both males and females, attending ART Centre, at Katihar Medical College, Katihar, Bihar. Various haematological parameters were recorded and studied with respect to CD4 count. Results: Among the total patients, 57.5% had anaemia, 23.75% had leucopenia and 12.5% had thrombocytopenia. The magnitude of these abnormalities were directly proportional to low CD4 counts. Results: Among the total patients, 57.5% had anaemia, 23.75% had leucopenia and 12.5% had thrombocytopenia. The magnitude of these abnormalities were directly proportional to low CD4 counts.  Conclusions: These hematological parameters can be used to assess the severity and progression of HIV as they are directly associated with CD4 count. Anaemia being the single most independent factor associated with high mortality. Aggressive treatment of these haematological abnormalities can lead to substantial decline in morbidity and mortality associated with HIV patients.

Infantile Hepatic Hemangioendothelioma (IHHE) – An Unusual Presentation.

Hepatic tumours are relatively rare in children, accounting for 1% - 4% of all paediatric solid tumors, commonest amongst them are hepatoblastoma, neuroblastoma, and vascular tumors (hemangioendothelioma/haemangiomas). Infantile Hepatic hemangioendothelioma (IHHE) is classically characterised by hepatomegaly, jaundice, congestive cardiac failure with high cardiac output, skin haemangiomas, haemolytic anemia, thrombocytopenia(kasabach – Merritt syndrome), normal Alfafeto protein (AFP) levels and hypothyroidism. We report a case of infantile hemangioendothelioma in a 5 day old female neonate with high output cardiac failure, unusually high alpha-fetoproteins, thrombocytosis and polycythaemia, which posed a diagnostic dilemma. Diffuse IHHE is a rapidly growing benign tumor which can lead to poor clinical outcome if not identified early. Serum AFP can’t be relied to exclude IHHE.

Major Depressive Disorder: Part-I: Personality and Phenomenology.

Objectives: To study the phenomenological variations in context of personality psychopathology in Major Depressive Disorder patients. Methods:36 indoor patients of psychiatry ward of tertiary level service out of total 168 admitted patients from Ist January 2008 to 31st Dec. 2008 diagnosed as Major Depressive Disorder (as per DSMIV TR) . Socio-demographic data on a self-designed Performa, Montgomery Asberg’s Depression Rating Scale (MADRS), Hamilton Anxiety rating scale (HARS)and Presumptive Stressful Life Event Scale(PSLE) were applied to these patients and they were observed every alternate day till discharge. International Personality Disorder Examination (IPDE) was applied on their third follow-up visit, which ranged from 6 to8 weeks. Results: Sociodemographic variables by enlarge didn’t make a difference in MADRS score. MADRS score was significantly higher with increasing episodes of illness. Personality disorder patients had significantly higher MADRS score than Double traits (t=3.47, df=27, p<0.01) and Single trait (t=4.056, df=23, p<0.001) personality psychopathology. Higher level of depression in Personality disorder patients in all components of depression like sadness, reduced sleep pessimistic and suicidal thought etc were reported. Presence of stress with personality psychopathology added greater severity to depression. Conclusion: Our study brings out constitutional vulnerability with adverse environmental conditions were associated with higher level of psychopathology.

Microspheres in cancer therapy.

Cancer microsphere technology is the latest trend in cancer therapy. It helps the pharmacist to formulate the product with maximum therapeutic value and minimum or negligible range side effects. Cancer is a disease in which the abnormal cells are quite similar to the normal cells, with just minute genetic or functional change. A major disadvantage of anticancer drugs is their lack of selectivity for tumor tissue alone, which causes severe side effects and results in low cure rates. Thus, it is very difficult to target abnormal cells by the conventional method of the drug delivery system. Microsphere technology is probably the only method that can be used for site-specific action, without causing significant side effects on normal cells. This review article describes various microspheres that have been prepared or formulated to exploit microsphere technology for targeted drug therapy in various cancers. We looked at the usefulness of microspheres as a tool for cancer therapy. The current review has been done using PubMed and Medline search with keywords.

Major Depressive Disorder: Part-II -Comorbid Anxiety Disorders.

Objective: To demonstrate that Anxiety Disorder comorbidity is reflection of underlying common risk factors (Anxiety proneness) in Major Depressive Disorder patients and may not be a separate disorder. We hypothesized that “Anxious personality traits or disorders under stress take the form of state that is Anxiety Disorders”. Methods:36 indoor patients of psychiatry ward of tertiary level services, out of total 168 admitted patients from Ist January 2008 to 31st Dec. 2008 diagnosed as Major Depressive Disorder (as per DSMIV TR). Socio-demographic data on a self-designed Performa, Montgomery Asberg’s Depression Rating Scale (MADRS), Hamilton Anxiety rating scale (HARS) and Presumptive Stressful Life Event Scale (PSLE) were applied to these patients and they were observed every alternate day till discharge. International Personality Disorder Examination (IPDE) was applied on their third follow-up visit, which ranged from 6 to8 weeks. Results: High level of co-existence of Anxiety disorder 29(80.5%) in the study sample, 11 patients (30.55%) of Major Depressive Disorder had personality disorder level of psychopathology and 18(50%) patient of Major Depressive Disorder had double or more personality traits psychopathology and there were 7(19.45%) patients of Major Depressive Disorder had only single trait personality psychopathology. Conclusion: This work support the gene environmental diathesis where vulnerable person under stress develop Axis I disorder which are considered currently as co morbid disorders.

Incidence and nature of complications arising from chronic alcoholism in West Nepal.

Medical complications caused by alcoholism are well documented. Alcoholism is among the leading causes of death in most parts of the world. However, many alcohol-related deaths go unreported, especially in developing countries. Nepal is no exception, and next to smoking, alcoholism is the most common preventable cause of death, especially in the western region. This study attempts to document the various common complications arising from chronic abuse of alcohol in this part of Nepal.

Comparison of cefoxitin disc diffusion test, oxacillin screen agar, and PCR for mecA gene for detection of MRSA.

Cefoxitin is a potent inducer of the mecA regulatory system. It is being recommended for detection of methicillin resistance in Staphylococcus aureus (MRSA) when using disk diffusion testing. The aim of our study was to evaluate the efficacy of cefoxitin disc diffusion test to characterize MRSA and compare it with oxacillin agar screening and detection of mecA gene by PCR. MATERIALS AND METHODS: Fifty strains of S. aureus isolated from clinical samples were used in the study. Routine antibiotic susceptibility testing was performed including oxacillin disk. Oxacillin screen agar plates with 4% NaCl and 6 microg/ml of oxacillin were inoculated and interpreted as per standard guidelines. Cefoxitin disc diffusion test was performed using 30 microg disc and zone sizes were measured. PCR for amplification of the mecA gene was performed. RESULTS: Out of the 50 isolates, 28 were found to be methicillin resistant by oxacillin disc diffusion test, 30 were resistant by oxacillin screen agar method, and 32 were resistant with cefoxitin disc diffusion. For these 32 isolates mecA gene was positive. CONCLUSION: Results of cefoxitin disc diffusion test is in concordance with the PCR for mecA gene. Thus, the test can be an alternative to PCR for detection of MRSA in resource constraint settings.

Management of respiratory failure in severe neuroparalytic snake envenomation.

Fourteen patients with severe neuroparalytic snake envenomation, resulting in acute type II respiratory failure, admitted to respiratory critical care unit for mechanical ventilation during one year period, were studied. Ventilatory requirements, amount of anti snake venom (ASV) infused, period of neurological recovery and hospital survival were evaluated. All patients had severe manifestations such as ptosis, extraocular muscle paresis and limb weakness along with dyspnoea. Seven patients (50%) had additional complaints of dysphagia and dysphonia. ASV was administered to all, with a median requirement of 900 ml. Mechanical ventilation was required for a median duration of 17 hours and all except one patient, who had suffered irreversible hypoxic cerebral injury prior to resuscitation, survived with complete neurological recovery. We conclude, that the timely institution of ventilatory support and anti-venom therapy in such patients, is associated with an excellent outcome.

Incidence of tuberculosis among patients receiving treatment with oral corticosteroids.

OBJECTIVES: To study the incidence and pattern of tuberculosis in patients taking systemic corticosteroids (CS). METHODS: Seventy seven patients taking oral CS for various respiratory diseases and eighty patients suffering from similar diseases but not receiving steroids were followed up for one year to study the incidence of tuberculosis. RESULTS: Five patients (6.5%) receiving CS developed tuberculosis as against none amongst the controls (p < 0.05). Of these, three patients had sputum positive pulmonary tuberculosis and one each had sputum negative pulmonary tuberculosis and tubercular meningitis. All patients were treated with standard anti-tubercular therapy; four patients improved whereas one died due to complications of disease. CONCLUSION: Systemic CS therapy causes a significant increase in incidence of tuberculosis.

Pulmonary function changes after large volume paracentesis.

OBJECTIVE: To study the effect of large volume paracentesis (LVP) on pulmonary function in patients with cirrhosis of liver and tense ascites. METHODS: Ten patients having alcoholic cirrhosis with ascites were subjected to LVP (mean 6.3 +/- 0.3 L). Pre and post paracentesis spirometry and arterial blood gas analysis were performed and compared. RESULTS: Baseline mean lung volumes and arterial pO2 were reduced from normal predicted values. Air flow was found normal. After LVP, an increase in absolute values of vital capacity, forced expiratory flow in first second (FEV1) and peak expiratory flow was observed; only the improvement in FEV1 was significant p 0.05). Arterial pO2 also showed significant (p < 0.01) improvement after LVP. CONCLUSION: LVP leads to improvement in measured pulmonary function.

Infertility and psychosexual disorders: relationship in infertile couples.

175 consecutive infertile couples were interviewed together and individually in accordance with a 25 point questionnaire. Amongst the males, premature ejaculations 66% was most common problem followed by erectile dysfunction 15%, decreased libido 11% and orgasmic failure 8%. Amongst females dyspareunia 58%, decreased libido 28% and orgasmic failure 14% were most common problems. Various type of misconceptions were also observed in the infertile couples. Lack of sexual awareness and education formed an important part of observations. Psychosexual dysfunction and infertility was found to occur, in a large number of couples, together in association. Most common cause for this problem seems to be ignorance and lack of sex education.

Role of doctors in prevention of torture.

Torture is taking place since time immemorial. Doctors can take important part in elimination of this social evil. Torture is deliberate, systematic or wanton infliction of physical or mental suffering by one or more persons to force another person or torture victim to make confession or giving information. Torture happens to occur in 3 forms--physical, mental and/or sexual. Doctors working in prisons, police or paramilitary/military forces are most likely to confront with torture and they should follow the medical ethics, codes and conventions in true sense. MCI, IMA, WMA should play their role in educating, motivating and supporting doctors in confronting torture. NHRC and IMA should co-operate each other to protect human rights.

Acute respiratory distress syndrome complicating typhoid fever.

We report a case of a young female patient with typhoid fever whose clinical course was complicated by hypotension, thrombocytopenia, encephalopathy and acute respiratory distress syndrome (ARDS). She recovered with prompt mechanical ventilatory support. ARDS in typhoid fever has generally proved to be fatal in reported cases.