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The symptoms associated with empty sella syndrome (ESS) include headache, giddiness, vomiting, visual field deficits, and endocrine problems, as well as the radiological appearance of an enlarged sella turcica. This case report highlights a 45-year-old female who had a COVID-19 infection 2 months back and presented with chronic headache, giddiness, and lethargy having persistent hyponatremia later diagnosed as empty sella syndrome on brain magnetic resonance imaging. In this case, we tried to correlate all of these clinical and radiological features as COVID-19 sequelae due to post-Covid hypothalamic-pituitary axis dysfunction.Copyright © 2023 Authors. All rights reserved.
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Background Human granulocytic anaplasmosis (HGA) is a tick-borne disease caused by Anaplasma phagocytophilum. The most common presenting features are transaminitis, leukopenia, thrombocytopenia, fever, and malaise. HGA causing cardiomyopathy likely from myocarditis is uncommon but a serious complication. Case A 70 year-old male with a history of coronary artery disease presented with fever (38.3 C) and dyspnea on exertion. He was found to have hypoxic respiratory failure, pancytopenia, acute kidney injury and transaminitis. He was treated empirically with ceftriaxone and doxycline. Baseline electrocardiogram was unremarkable for ischemia. However, he had troponin elevation and was decompensated on exam. Bedside transthoracic echocardiogram (TTE) showed LVEF of 20-25% for which he was administered dobutamine and monitored in intensive care unit (ICU). Repeat TTE illustrated LVEF 30-35% with moderate diffuse hypokinesis of LV. Blood and urine cultures were negative. He tested positive for Anaplasma DNA-PCR with unremarkable rest of the tick borne, viral and parasitic panel. He was then continued with doxycycline for 14 days for sepsis due to Anaplasmosis. Follow up TTE in a month showed improved LVEF to 40% with resolution of his symptoms. Decision-making Our patient presented with common tick-borne illness symptoms and signs, which prompted initiation of empiric antibiotics. However, the significantly reduced LVEF and elevated troponins were concerning for which he was monitored in ICU. Cardiac magnetic resonance imaging was not pursued due to delay in transfer process to the higher center amidst COVID pandemic and ongoing sepsis due to Anaplasmosis. After the results of HGA PCR, he was continued on a 14-day course of doxycycline which eventually resolved his symptoms. Conclusion There must be a high level of suspicion for cardiomyopathy if the patient is being empirically treated for tick-borne illness and has decompensated heart failure symptoms. PCR is the most sensitive test for diagnosing HGA. However, the test results should not delay the treatment as tick-borne illness responds well to doxycycline which should alleviate the heart failure symptoms as seen in our case.Copyright © 2023 American College of Cardiology Foundation
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In light of the ongoing COVID-19 pandemic, it is important to analyse the ventilation system of an AC coach for safer as well as comfortable ride. In this study we have simulated the airflow, temperature distribution and velocity distribution inside the cabin, to find out the best layout for comfortable temperature as well as reduced chances of airborne infection. We have simulated various ventilation layouts of the 2 tier AC train coach of Indian Railways, to study the effect of the position of the inlet and outlet ports on the temperature and velocity distribution inside the cabin. CFD analysis was done using the Ansys Fluent solver employing the realizable k-ε model to solve the turbulence problem. Herein, a total of 12 layouts were simulated with 6 heated manikins sitting inside the cabin. The results of the study suggested that the temperature distribution inside the cabin changes significantly with a change in the inlet port position. Further, the layout with the above window and/or roof outlet has a relatively lower cabin temperature. This study forms the basis for further investigations to analyse the transmission of infection via cough droplets inside the cabin (unreported here). The results of this research are important for finding the optimum position of the inlet and outlet ports in AC coaches to enhance the overall thermal comfort and reduce infection transmission inside the cabin. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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The primary complaint of a 48-year-old male patient in an Indian hospital was pain in the upper left rear region of the jaw. The patient appeared to be in good health until one and a half months ago, when he began experiencing pain over the upper left back side of his jaw. The patient was taken to the hospital two months ago after testing positive for COVID-19. He was maintained on oxygen for 10 days while receiving Remdesivir injections and steroid therapy. The patient has had diabetes mellitus and hypertension for five years and is currently on medication for both. An MRI of the brain and orbit was performed on the patient. The patient had functional endoscopic sinus surgery (FESS), which is a minimally invasive procedure that restores sinus ventilation and function. The patient was admitted to the hospital for 20 days and given injections of Amphotericin-B(12 doses). Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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In light of the ongoing COVID-19 pandemic, it is important to analyse the ventilation system of an AC coach for safer as well as comfortable ride. In this study we have simulated the airflow, temperature distribution and velocity distribution inside the cabin, to find out the best layout for comfortable temperature as well as reduced chances of airborne infection. We have simulated various ventilation layouts of the 2 tier AC train coach of Indian Railways, to study the effect of the position of the inlet and outlet ports on the temperature and velocity distribution inside the cabin. CFD analysis was done using the Ansys Fluent solver employing the realizable k-ε model to solve the turbulence problem. Herein, a total of 12 layouts were simulated with 6 heated manikins sitting inside the cabin. The results of the study suggested that the temperature distribution inside the cabin changes significantly with a change in the inlet port position. Further, the layout with the above window and/or roof outlet has a relatively lower cabin temperature. This study forms the basis for further investigations to analyse the transmission of infection via cough droplets inside the cabin (unreported here). The results of this research are important for finding the optimum position of the inlet and outlet ports in AC coaches to enhance the overall thermal comfort and reduce infection transmission inside the cabin. © 2023, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Background Lifestyle is an important factor to individual's health and quality of life. Although, the emergence of Corona virus disease 2019 (COVID-19) has forced billions of people to change their lifestyle overnight. Objective To identify health promoting lifestyle during COVID-19 pandemic among the residents of Gandaki Province, Nepal. Method Descriptive cross sectional web based study was conducted among 386 respondents from Gandaki Province. Adults from 18 years and above, who could fill the form online were included using purposive and snowball sampling technique. Data were collected using Health Promoting Lifestyle Profile II (HPLP II) scale and analysed using descriptive (frequency, percentage, median) and inferential statistics (Mann Whitney U test and Kruskal Wallis test). Result Only 18.7% of the respondents had an excellent health promoting lifestyle followed by good health promoting lifestyle among 60.4%. Highest median score was observed in spiritual 27(10-36), and interpersonal relationship subscale 27(9-36). Whereas, the lowest was observed in physical activity 21(8-32) followed by stress management 24(10-32). Statistically significant difference was observed in age and perception of own health status with spirituality;gender, chronic illness and perception of own health status with interpersonal subscale and age, gender, marital status, occupation and perception of own health status with physical subscale. Conclusion The study concludes the need of health education and awareness to promote healthy lifestyle behaviours with a particular emphasis on indoor physical activities and stress management skills with specific consideration to female and elderly. Copyright © 2022, Kathmandu University. All rights reserved.
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The coronavirus disease 2019 pandemic (COVID-19) has led to considerable hike in hospitalizations for pneumonia with multiorgan disease requiring immediate hospital care, maintenance of oxygen saturation level, and severe cases requiring mechanical ventilation. This opens the window of opportunity to microscopic organisms such as different species of fungus including Candida, Aspergillus, Rhizopus, and Cryptococcus adding other fungi causing opportunistic invasive fungal infections (OIFIs), and other bacteria to cause concurrent infections in COVID-19-diseased patients which on occasion not promptly diagnosed and are mostly diagnosed after death, which get chance due to invasive procedures such as intubation and immunosuppressant drugs which mostly consists of corticosteroids, patient with diabetes mellitus or any other chronic disease causing immunosuppression, patient having a history of chronic obstructive airway disease, development of antibiotic resistance, and vulnerability of pulmonary tissues regarding developing colony for mycotic infections. In this review, we talk over the character of mycotic concurrent infections in aggravation of COVID-19 disease severity and focus on arising trends associated with fungal infections in coronavirus-diseased (COVID-19 diseased) cases. In addition, this review impart the view on the risky component for concurrent mycotic infections in COVID-19 diseased patients who are hospitalized and focuses the possible task of extended immunemodulatory treatments in managing concurrent mycotic infections, comprising COVID-19-associated pulmonary aspergillosis, COVID-19-associated Candidiasis, and mucormycosis. This article restates the demand for prompt detection regarding presumed COVID-19-related systematic mycosis in the health-care settings which could empower fast OIFI diagnosis, treatment, and lowers the mortality rate.
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SESSION TITLE: What Lessons Will We Take From the Pandemic? SESSION TYPE: Rapid Fire Original Inv PRESENTED ON: 10/19/2022 11:15 am - 12:15 pm PURPOSE: Post COVID pulmonary complications can be attributed to severe inflammatory response that can result in pulmonary fibrosis. It is somewhat predictable in patients with severe illness, advanced age and comorbidities. However, a little is known about pulmonary complications in younger patients with mild illness followed up at outpatient clinics. We aim to shed light on post COVID pulmonary complications in patients who did not require hospitalization but had significant outpatient visits. METHODS: This study is based upon a retrospective chart review of patients who presented to Pulmonology Clinic at Cayuga Medical Associates with respiratory symptoms associated with COVID-19 disease. Mild illness was defined as symptoms of dyspnea on exertion or fatigue or shortness of breath that have not required oxygen and lasted for less than or equal to two months. Moderate illness was defined as symptoms of mild illness lasting for more than two months without oxygen supplementation. Severe illness was defined as hypoxia requiring home oxygen. We have excluded the patients who were hospitalized for COVID pneumonia. RESULTS: Of 23 patients (56.52% female) with COVID illness seen at Pulmonology Clinic in one-year duration, 13.04% had COPD, 26.09% had asthma and 21.74% had OSA. Median age was 33 with mean BMI 27.61.13.04% were current smokers. 39.13% required a PFT among which 77.78% had normal results. 21.74% of the total patients who never had OSA as an underlying diagnosis, required sleep study, among which 60% had mild OSA and 20% had severe OSA. 13.04% were already on oral steroids for other diseases. Majority of the patients had normal chest x-ray findings. 39.13% had CT chest, majority of which showed normal findings and few with diffuse ground glass opacities. 8.70% developed palpitations along with respiratory symptoms. At six months follow up, 43.48% had mild illness who were managed with conservative management such as incentive spirometry, deep breathing techniques, prone positioning and as needed short acting bronchodilator treatments. 43.48% had moderate illness who were treated with short course of oral steroids in addition to conservative management. 13.04% had severe illness who required home oxygen up to 2 L for two months maximum. Most common pulmonary complaint was dyspnea on exertion, seen in 43.48%. 17.39% had fatigue. 21.74% had sleep apnea symptoms. Median duration of symptoms was two months. CONCLUSIONS: Our study outlines the incidence of post COVID pulmonary complications in patient group where these complications are least expected. CLINICAL IMPLICATIONS: Post COVID pulmonary complications appear to be of significant concern in patients visiting outpatient clinics. The heterogeneity in management of those complications needs a serious attention. The feasibility and implementation strategy of post COVID-19-care-clinic with proper management guidelines should be brought to streamline practice. DISCLOSURES: No relevant relationships by Sameer Acharya No relevant relationships by Ali AKRAM No relevant relationships by Samjhauta Bhattarai No relevant relationships by Lavanya Kodali
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Mucormycosis or zygomycosis is a life threatening invasive fungal infection, usually seen in patients with alteration of their immune system. It is a lethal and an aggressive fungal infection caused by the fungi of the order Mucorales. The angioinvasive property of mucormycosis can lead to fatal complications such as intracranial bleed. Acute pancreatitis refers to inflammation of the pancreas which presents mainly as acute pain in the abdomen and is a potentially fatal condition. The association of mucormycosis with acute pancreatitis is rare but dangerous. This case report highlights a case of 32-year-old male patient, with no co-morbidities, who was admitted to an rural central Indian hospital with four days of abdominal pain and two days of headache. Patient appeared to be in good health prior to this event. He was ultimately diagnosed with mucormycosis of paranasal sinus with acute pancreatitis. The patient was treated with intravenous antifungals, antibiotics and fluid therapy along with other supportive measures. Patient later developed intracranial bleed five days after admission, and ultimately succumbed on day seven of admission. After an extensive review of literature it was found that this is the first article to report mucormycosis, acute pancreatitis and intracranial bleed all occurring at once in an immunocompetent male.
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Background: Cervical cancer is the leading cause of cancer and cancer-related deaths among women in Nepal, due in part to a lack of access to screening and limited medical providers trained to diagnose and treat women with preinvasive cervical disease. Cancer Care Nepal has partnered with The University of Texas MD Anderson Cancer Center (MD Anderson) and the American Society of Clinical Oncology (ASCO) to implement a 'train the trainer' (TOT) program to teach visual inspection with acetic acid (VIA), colposcopy, cervical biopsy, cryotherapy, thermal ablation, and loop electrosurgical excision procedure (LEEP). Methods: An initial cervical cancer prevention course was held in Kathmandu, Nepal in November 2019, supported by ASCO and with faculty from Civil Service Hospital, Bhaktapur Cancer Hospital, and National Academy of Medical Sciences and MD Anderson. As a continuation of this program, a TOT course was implemented for local specialists from five participating institutions throughout Nepal to learn how to deliver these trainings. Each participating institution then holds their own local course for nurses and doctors in their region. The training is complemented with monthly Project ECHO (Extension for Community Healthcare Outcomes) telementoring videoconferences. Results: The program was launched in November 2021. To date, two TOT training courses (2-day duration) have been held for clinicians from the 5 participating regions. Due to COVID-19 pandemic travel restrictions, didactic lectures were held virtually with MD Anderson and ASCO staff and included epidemiology of cervical cancer, screening guidelines, colposcopy, and treatment of cervical dysplasia. This was followed by hands-on training using simulation models to teach VIA, colposcopy, ablation and LEEP, led by the Nepalese faculty who had participated in the 2019 course. There were 41 participants in total (23 in the first course and 18 in the second course), including 21 gynecologists, 4 gynecologic oncologists, 1 medical oncologist, 1 general practitioner, and 14 nurses. 39 participants (73%) completed both the pre-and post-survey results. 86% of respondents from the first course and 100% of respondents from the second course reported that they intended to change their practice as a result of knowledge gained from the course. In addition, Cancer Care Nepal became a new hub for Project ECHO and held its first session in January 2022, with 20 participants representing two regions. The specialists from each of the 5 participating sites will be holding local courses for doctors and nurses in their respective regions throughout 2022. Conclusions: Our work shows that the TOT strategy can widen the reach of training in cervical cancer prevention in Nepal. Despite travel restrictions during the COVID-19 pandemic, global health training and mentoring can continue, though they require adaptions and use of virtual platforms.
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The pathogenic RNA virus that infects human beings contains the RNA helicase enzyme, responsible for the replication of the viral genome. The enzyme is used as a suitable target against which the drug molecule acts. Therefore, the identification and proposal the novel compounds that can be targeted toward the helicase enzymes to stop the functioning of the enzyme is desirable. Although many viral helicase inhibitor molecules have been identified, still yet no unique database is available for these compounds. This research work envisages developing a curated database of RNA helicase inhibitors. The database contains in total of 353 entries that are computationally predicted and experimentally verified RNA helicase inhibitors. The database contains information like compound name, chemical properties, chemical format, and name of the target virus to which it acts against it with a user-friendly menu-driven search engine. Presently, the database is freely available at: https://vhimdb.rsatpathy.in/. Further, in silico screening of the whole database by drug-likeness and toxicity resulted in 14 potential drug molecules. The selected molecules were analyzed for their effectiveness in binding by using molecular docking score and interaction with the helicase enzymes of three categories of pathogenic viruses (SARS-CoV-2, SARS-CoV, and MERS-CoV).
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Background: The purpose of this study was to investigate the depressive symptoms among migrant workers in South Korea amid the coronavirus disease 2019 pandemic. Methods: This web-based cross-sectional survey involved migrant workers in South Korea to examine their depression levels using the Patient Health Questionnaire-9 scale. Logistic regression was used to find out the factors associated with depression. Results: Migrant workers exhibited mild to severe depressive symptoms (98.4%) of which 41.7% had severe depression (n = 161). Migrant workers aged above 25 years were shown to have a significantly higher level of depression (odds ratio = 2.13, 95% CI: 1.084-4.193). Male workers (71.1%) had a higher depression level than females (28.9%). Losing a job during the coronavirus disease 2019 pandemic (odds ratio = 3.89, 95% CI = 1.705-8.906) and not having any social relief support (odds ratio = 1.92, 95% CI: 1.109-3.351) were significantly associated with depression. Conclusion: Migrants workers were found to be experiencing a severe level of depression. Mental healthcare should be prioritized and made accessible to vulnerable and risk groups.
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This study investigates the ways to provide unhindered entertainment solutions to artists and common people. The research has led to the conclusion that a new social media platform can be built for artists around the globe. The aim of the study is to merge video conferencing features with face detection and smile detection machine learning algorithms to provide an interactive environment to audience virtually over Internet. The findings of the study suggest that people from different age groups and places can find the comedy shows of common interests for enjoyment. The project can be launched as application to build a worldwide community of comedians. The paper is intended to provide a fast and efficient Machine learning model to detect smiling faces in real time environment with low latency and high accuracy. The comparison between some smile detection models is done among which our model has proven to be more effective than 2 pre-existing models with accuracy score of 91.97%. Although the accuracy of this model is less than other one having 94.87% accuracy. © 2022 IEEE.
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COVID-19 (Coronavirus infectious disease 2019) denotes an ever changing and varied disease which has crippled the health care systems throughout the world. There have been studies conducted across the globe to establish the important factors for severity and mortality associated with COVID-19. We tried to study the effect of chronic obstructive pulmonary disease (COPD) on the severity as well as outcome of COVID-19. Material and methods: A total of 180 patients with COVID-19 were enrolled in this study and were then screened for history of COPD. There were 49 patients with history of COPD and 131 patients with no history of COPD. Inflammatory markers and HRCT scores were assessed for all the patients and they were followed up to study the outcome. Result: COPD was significantly associated HRCT Score, inflammatory markers and outcome. The mean HRCT Score for patients with COPD was more in COPD group (15.39 +/- 4.65) when compared with Non-COPD group (9.39 +/- 3.98). Mortality was also significantly higher in patients with COPD (67.3%) when compared to the patients without COPD (3.3%). Conclusion: We conclude that COPD is an important factor which has to be considered while treating the patients of COVID-19 especially in the rural India where lockdown restrictions and lack of knowledge have provided hinderance in achieving optimal follow up as there is increased severity and mortality associated with it.
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Objective: In response to the coronavirus disease 2019 pandemic, the use of virtual appointments increased substantially. An audit was designed to evaluate the efficacy of virtual appointments at Alder Hey Children's Hospital. Patients and clinicians satisfaction of virtual appointments were also recorded. Materials and Methods: Patients having virtual appointments were identified, and data were recorded, including demographics and outcome of the appointment. A pilot study was conducted to identify any necessary modifications to the data collection process. Data were collected over two cycles, and the results were analyzed. Results: The first cycle was performed retrospectively and there were 158 patients identified who had a virtual appointment. An outcome could be drawn from the virtual appointment in over 70% of cases. Recommendations following the first cycle were implemented. A second cycle was then completed prospectively. A total of 145 patients were identified. An outcome could be drawn in 51% of cases. Patient and clinician feedback on virtual appointments was generally positive. Conclusion: This study demonstrated that a successful outcome could be drawn in the majority of virtual appointments, and clinicians and patients had positive experiences regarding virtual clinics. This highlights the usefulness of this service, which is particularly relevant due to the increased reliance on virtual clinics during the pandemic. © 2022. The Author(s).
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Derangements in coagulation profile due to on-going anticoagulant medication can complicate the most primitive physiology in a woman, ovulation. Unmonitored anticoagulant therapy can lead to an array of complications, one of which is intraperitoneal haemorrhage secondary to numerous medical and surgical conditions. The resultant haemoperitoneum can cause sudden hypovolemic shock, especially in a patient with compromised cardiovascular status. This report narrates the case of a 30 years old nulliparous female patient on anticoagulant therapy, operated for multiple cardiac defects and developed massive haemoperitoneum as a consequence of ovulation. The patient presented in shock to the Emergency Department with unstable haemodynamic status. A multi-disciplinary approach to the case converged on ruptured functional ovarian cyst as a working diagnosis. Conservative management of haemoperitoneum was decided upon, whereby correcting shock and providing pro-coagulant therapy along with blood products was the main line of management. All efforts failed soon after when the cyst wall ruptured catastrophically, leading to collapse of the general condition of the patient. Surgical approach was undertaken and a ruptured ovarian cyst wall was identified to be the cause. The cyst wall was subsequently repaired electrosurgically and the patient recovered well with an uneventful postoperative period. However, the characteristic feature of this case is the lack of follow-up due to lockdown restrictions of this continuum, the Coronavirus Disease-2019 (COVID-19) pandemic. The management of such cases must be carefully titrated, keeping in mind the risks and benefits of both pro-coagulant and anti-coagulant therapy wherein one can jeopardise the effects of the other.
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Introduction: Coronavirus disease (COVID-19) pandemic has affected large number of people globally and has continued to spread. Preparedness of individual nations and the hospitals is important to effectively deal with the surge of cases. We aimed to obtain nation wide data from Nepal, about hospital preparedness for COVID-19.
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The recent emergence of COVID-19 has drawn attention to the various methods of disease control. Since no proper treatment is available till date and the vaccination is restricted to certain age groups, also vaccine efficacy is still under progress, the emphasis has been given to the method of isolation and quarantine. This control is induced by tracing the contacts of the infectious individuals, putting them to the quarantine class and based on their symptoms, classifying them either as the susceptible or sick individuals and moving the sick individuals to the isolated class. To track the current pandemic situation of COVID-19 in India, we consider an extended Susceptible-Exposed-Quarantine-Infected-Isolated-Recovered (SEQ(1)IQ(2)R) compartmental model along with calculating its control reproductive number R-c . The disease can be kept in control if the value of R-c remains below one. This "threshold" value of R-c is used to optimize the period of quarantine, and isolation and have been calculated in order to eradicate the disease. The sensitivity analysis of R-c with respect to the quarantine and isolation period has also been done. Partial rank correlation coefficient method is applied to identify the most significant parameters involved in R-c. Based on the observed data, 7-days moving average curves are plotted for prelockdown, lockdown and unlock 1 phases. Following the trend of the curves for the infection, a generalized exponential function is used to estimate the data, and corresponding 95% confidence intervals are simulated to estimate the parameters. The effect of control measures such as quarantine and isolation are discussed. Following various mathematical and statistical tools, we systematically explore the impact of lockdown strategy in order to control the recent outbreak of COVID-19 transmission in India.