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Introduction: Ivermectin is an antiparasitic medication that is primarily metabolized by the liver. During the COVID-19 pandemic, researchers demonstrated that Ivermectin successfully inhibited the replication of SARS-COV-2 in vivo, but current research has failed to demonstrate clinical benefit for treatment of COVID-19. Despite this, misinformation campaigns have misled patients to ingest Ivermectin at concentrations meant for domestic animals. Here, we present a case of acute liver failure secondary to the use of Ivermectin. Case Description/Methods: A 61-year-old man with medical history of ischemic cardiomyopathy with last echocardiogram showing ejection fraction at 21%, atrial fibrillation on warfarin for oral anticoagulation, and previously treated Hepatitis C presented with generalized weakness and yellowish discoloration of the skin worsening over the last two weeks. The patient denied significant alcohol use, acetaminophen use, or illicit drugs. He admitted to injecting himself with two doses of weight-based horse ivermectin, for COVID prophylaxis, two weeks prior to his presentation. Physical exam was pertinent for scleral icterus and hepatomegaly with no abdominal tenderness. Initial labs revealed elevated liver chemistries in a mixed pattern (Figure 1). Acute hepatitis panel, HSV, and CMV were negative. Hepatitis C antibodies were positive, but the patient was in sustained virologic response. Full workup for chronic liver disease was unremarkable. Ultrasound revealed hepatosplenomegaly with patent portal and hepatic vasculature. Subsequently, the patient developed hepatic encephalopathy along with his coagulopathy, raising concern for acute hepatic failure. The patient was transferred to the ICU and started on NAcetylcysteine, rifaximin, and supportive care. The patient recovered well and fortunately did not require liver transplant. Discussion(s): While the FDA recommends against the use of Ivermectin for COVID-19, many continue to inappropriately consume it. Ivermectin-induced liver failure is a rare but deadly side effect. Given our patient's rapid onset of symptoms post-self injection of Ivermectin, his liver injury was presumed to be related to Ivermectin. The drug interaction between Ivermectin and warfarin had worsened the patients coagulopathy. Physicians should be aware of the ways Ivermectin overdose may clinically present to avoid delayed treatment. This case demonstrates the detriments of perpetuation of medical misinformation to care.
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Background: The COVID-19 pandemic has led to a dramatic loss of human life worldwide and presents an unprecedented challenge for healthcare systems worldwide. Earlier to SARS-CoV pandemic, coronaviruses were only thought to cause mild, self-limiting upper respiratory tract infections in humans. COVID 19 presents across a spectrum of symptoms. WHO recommends detection of unique sequences of virus RNA by Nucleic Acid Amplification Test (NAAT) such as real-time reverse-transcriptase polymerase chain reaction (rRT-PCR). The aim of this cross sectional study was analysis and confirmation of Nasopharyngeal/oropharyngeal swab specimen by real-time reverse transcription polymerase chain reaction (RT-PCR). Material & Methods: This was a cross-sectional retrospective study that reviewed records of samples collected from June 2021 to March 2022. Nasopharyngeal/oropharyngeal swab specimen were collected from suspected COVID-19 subjects of various districts of Punjab and referred to Viral Research Diagnostic Laboratory [VRDL], Government Medical College [GMC], Amritsar for laboratory analysis and confirmation by real-time reverse transcription polymerase chain reaction (RT-PCR). Results: During the present study, a total of 11,27,005 samples were analyzed from June 2021 to March 2022 for SARS-CoV-2 detection by ICMR approved COVID-19 RT-PCR kits. Out of total 11,27,005 cases, 24,466 cases (2.17%) were found to be SARS-CoV-2 positive while 11,02,539 cases (97.83%) were SARS-CoV-2 negative. Conclusions: Ever since the COVID-19 global pandemic emerged, the developing countries are facing challenges regarding its diagnosis. Isolation of the infected person will eventually decrease the Reproduction number i.e Ro which will further interrupt the transmission cycle leading to decrease in community spread.
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Background: SARS-CoV-2 infection poses tremendous challenge to the healthcare system of nations across the globe. Healthcare workers (HCWs) are crucial to the ongoing response to the SARS-CoV-2 pandemic. During the course of their work, they are exposed to hazards that place them at the risk of infection. Serological testing for SARS-CoV2 among healthcare workers, which form a high risk group helps in identifying the burden of hidden infection in an institutional setting. The present study aims to investigate the seroprevalence of IgG antibodies against SARS-CoV-2 among HCWs during 1st and 2nd wave. Material & Methods: A prospective study was conducted at Viral Research and Diagnostic Laboratory, Government Medical College, Amritsar during June July 2020 (1st wave)and April May 2021(2nd wave). During this period, 184 blood samples were collected from healthcare workers from Government Medical College and Hospital, Amritsar. Serum was separated and used for detection of Anti-SARS-CoV-2 IgG antibodies by ELISA technique. Results: Out of the 184 samples, 79 (42.9%) were found to be seropositive. Higher seropositivity was seen i.e 60.8% during the 2nd wave (April-May 2021) as compared to 25% during 1st wave. The increase in seroprevalence was observed in almost all categories of HCWs, Doctors 44.4% vz 13.04%, nurses 54.8% vz 34.7%, lab technicians 72% vz 30.4% and housekeeping staff 72.2% vz 21.7%. Also the unvaccinated HCWs showed higher seroprevalence during the second wave and 87.5% of vaccinated HCWs had demonstrable IgG antibodies. Conclusions: High seropositivity was observed among healthcare workers due to their nature of work. Rise of seropositivity among unvaccinated HCWs during 2nd wave concludes that increase in seroprevalence was attributable to natural infection. The vaccine's immunological response was also highlighted in the study.
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Background: Severe acute respiratory illness due to SARS-CoV-2 represents great global public health concern. The spectrum of disease ranges from mild to life-threatening. Surveillance of hospitalized patients with severe acute respiratory infections (SARI) is an important public health tool used to identify etiologies to understand the disease, track changes in circulating viruses and as an alert mechanism for potential pandemic viruses. We aim to find out the rate of SARS-CoV-2 positivity in SARI cases and further study the epidemiological and clinical characteristics of patients. Material & Methods: A Prospective study was conducted on 200 Severe Acute Respiratory Illness patients admitted at tertiary care hospital. The clinical, demographic, epidemiological, risk factors / co-morbidities of all the patients were recorded. Oropharyngeal and nasopharyngeal samples were collected and tested for SARS-CoV-2 by real time reverse transcriptase (RT-PCR) test. Results: Out of 200 SARI patients, 51 (25.5%) were tested positive for SARS-CoV-2. Maximum cases (54.90%) were in the age group of 41-60 years;males were infected predominantly (52.94%). The most common symptoms of presentation were fever (100%), cough (86.27%), dyspnoea (82.35%) and sore throat (56.86%). Comorbidities associated with COVID-19 were Hypertension (56.86%), Diabetes Mellitus (33.33%), Chronic Obstructive Pulmonary Disease (13.72%) and Coronary Artery disease (9.8%). More than 30% of the patients were admitted in ICU and 9.80% received mechanical ventilation. Conclusions: Evaluation of clinical and epidemiological profiles of SARI patients can help in understanding and managing the outbreak more efficiently. Close monitoring and quarantine will be required to prevent extensive transmission within the community.
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Background Cardiac rehabilitation (CR) has shown clinical benefit in heart transplant (HT) recipients. However, variable adherence with CR has been reported. We aimed to describe adherence and factors associated with CR cessation. Methods We performed a retrospective chart review of HT recipients who attended at least one CR session at a tertiary medical center (2013-2021). Complete adherence was defined as participation in all 36 CR sessions. We extracted participant age, sex, race, BMI, diabetes, creatinine clearance, post-operative complications (reoperation, major bleeding, infection, or need for dialysis), hospital length of stay, and METs on baseline exercise tolerance test prior to CR. We computed the proportion of HT recipients who did not complete CR, and then compared their characteristics to those of HT recipients with complete adherence using Kruskal Wallis tests and Fisher's Exact tests for continuous and categorical variables, respectively. Primary reasons for cessation were extracted from the electronic health record. Results There were 55 HT recipients (median age 55.9 years, 67.3% male) who attended CR;25 (45.5%) had complete adherence. Thirty did not complete CR (14 patients attended 1-12 sessions, 12 patients attended 13-24 sessions, and 4 patients attended 25-35 sessions) and participated in a median of 13 sessions (IQR 9-21). Within this group, 46.7% reported medical reasons for cessation, 20.0% for personal reasons, 13.3% for COVID-19 pandemic, 6.7% for insurance expense, 3.3% for relocation, and 3.3% for return to work or school. Patients who did not complete CR experienced more post-operative complications after HT (63.3% vs 32.0%, p = 0.03) but there were no other differences in characteristics between groups. Conclusion Nearly half of HT recipients in our sample had complete adherence to CR. Among those who did not complete CR, medical reasons were most commonly cited. Postoperative complications predicted CR cessation, but there were no other differences between groups, albeit with a relatively small sample size.Copyright © 2023 American College of Cardiology Foundation
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Background: COVID-19 is an infectious disease caused by the SARSCoV-2 virus. After a December 2019 outbreak in China, the World Health Organization identified SARS-CoV-2 as a new type of coronavirus. Currently, WHO recommends detection of unique sequences of virus RNA by rRT-PCR. ICMR also recommends use of CBNAAT using Cepheid Xpert Xpress SARS-CoV2. The aim of this study is to determine the prevalence of SARS-CoV-2 detected through CBNAAT. Material & Methods: This retrospective study was conducted from July 2020 to December 2021 at VRDL, GMC, Amritsar. The study group consisted of all the patients presenting with symptoms of Influenza Like Illness (ILI) and Severe Acute Respiratory Illness (SARI) who presented to hospital. The data was collected and subjected to statistical analysis. Results: During the present study, a total of 1,259 samples were analyzed for SARS-CoV-2 by CBNAAT from July 2020 to December 2021. Out of total 1,259 cases which were included in the study, 327 cases (25.97%) were found to be SARS-CoV-2 positive while 870 cases (69.10%) were SARSCoV-2 negative and 62 cases were found to be inconclusive. 62 inconclusive samples were further tested by RT-PCR. Out of which, 15 were RT-PCR positive and 47 were RT-PCR negative. Conclusions: The COVID-19 pandemic has put forward unprecedented challenge to the public health system across countries to prepare themselves for this current crisis which included isolation, contact tracing, quarantine and enforcement of a nation wide lockdown starting 25th March, 2020.
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Introduction: Idiosyncratic drug-induced liver injury (DILI) affects an estimated 19 per 100,000 persons yearly and is a major cause of acute liver failure. Drug-induced autoimmune liver disease (DIAILD) is a poorly defined and under-reported liver disorder, and probably an underestimated liver disease. A small number of drug-induced liver injury (DILI) cases exhibit features typical of autoimmune hepatitis (AIH). To differentiate between true AIH triggered by drugs (DI-AIH) and immune mediated DILI still remains a challenge. Case Description/Methods: We present a 71-year-old ICU nurse with past medical history of hyperlipidemia, hypothyroidism and GERD presenting for nausea, epigastric pain, and chills. Of note, 5 days prior to onset of symptoms she received her vaccine for COVID-19. Medications that she takes at home are cimetidine, Protonix, Lipitor, Synthroid, Zofran, Vitamin A, and D supplementation. Review of systems were pertinent for mild itching, nausea, and chills. Physical exam is unremarkable except for low grade fevers, scleral icterus, and jaundice. Labs are significant for T.bili 13.5, AST 1673, ALT 2372, ALP 246, INR 1.59, ANA 1:160, AFP 169, CT abdomen/pelvis with and without contrast was unremarkable except for mild constipation. Liver biopsy was obtained that revealed submassive hepatic multilobular necrosis with confluent lytic necrosis and cholestasis involving 60-70% of the cores. Portal triads showed surrounding lymphocytic infiltrate without bile duct involvement and active interface hepatitis. active interface hepatitis, . Per pathology report the histological findings were nonspecific and a diagnosis of drug toxicity is the most compatible with given history. She was started on prednisone 40 mg daily and her liver enzymes started to improve. Discussion: In our patient we attributed the acute liver injury secondary to cimetidine from immune mediated DILI. Initially we speculated that covid 19 vaccine could have attributed to her acute hepatitis. However, at the time there were no other cases reported of Covid 19 related acute liver injury;and it could have coincidentally occurred at the same time. It will be interesting to see in the future if Covid 19 vaccine presents similar to this case. Although it is a clinical challenge to differentiate AIH and DI-AIH;it is important to keep both conditions in your differential.
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The pandemic of COVID-19 disease caused by SARS-CoV-2 continues to be the global public health concern. While nations are taking extensive measures to contain the pandemic, several variants have been identified more recently due to mutations of the SARS -CoV 2 which make it highly contagious and well known source of multiple waves. A retrospective and observational study were conducted on 28,897 nasopharyngeal/ oropharyngeal swabs of patients consulted or hospitalized at tertiary care hospital. The Epidemiological, demographic & clinical details of all patients were recorded and the diagnosis of SARS- CoV 2 was done by real time reverse transcriptase reaction (RT-PCR). A total 4794(16.6 %) patients were tested positive for SARS CoV-2 & maximum cases (38.57%) were in age group 41-60 years;males (51.48%) were found to be predominantly infected .In year 2020 maximum positivity of SARS -CoV 2 were reported in the months of August & September (14.72%), then gradual decline from October to Feb 21 and then second wave lead to abrupt rise, 34.42% cases reported in the month of April- May 2021. More than 75% of positive patients were found to be symptomatic and the most frequent symptoms were fever (82.14%), cough (71.69%), and sore throat (43.5%). Severe acute respiratory illness (SARI) was detected in 38.06 % of positive cases & Influenza like illness (ILI) was reported in 11.28%. Fifty one (51) positive samples tested for whole genome sequencing, detected 56.8% B.1.1.7 lineage (alpha variant), (39.3%) B.1.617.2 lineage (delta variant) and 3.9% delta plus variants (A.Y 4 & A.Y 12). As the pandemic continues to unfold, there is need to analyse the epidemiogical & clinical characteristics of the patients infected with SARS CoV 2 and identification of ongoing variants of concern in the presence of new selection pressures such as vaccination.
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and its interpretation, a total of 3,47,418 samples from period of 01st April 2020 to 31st October 2020 were included in this study. Ribonucleic Acid amplification by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) of SARS-CoV-2 from nasopharyngeal/oropharyngeal swabs of all individuals revealed confirmation of 17,920 positive samples. Total 2,29,310 males and 1,18,108 females were tested for the COVID-19 infection. Social science statistics online tool (https://www.socscistatistics.com/tests/) was used for χ2 test to analyse different parameters. results: Maximum number of COVID-19 positive patients was detected in 21 to 30 years age group (p<0.05). Highest positivity ratio of samples was observed in individuals exceeding the age of 50 years. Number of asymptomatic individuals was found to be quite higher than symptomatic individuals in total population. Overall percent positivity of asymptomatic individuals was 4.81% (p<0.00001), which accounts to 4.71% of total number of tested individuals in this study. conclusion: COVID-19 is an evolving disease and data from this study elucidates the epidemiological profile of the SARS-CoV-2 infection among population of Majha region of Punjab state of Indian subcontinent. Introduction: There are many types of coronaviruses that causes respiratory and intestinal infection in humans. Among these coronaviruses, is a group of Severe Acute Respiratory Syndrome (SARS)-like bat coronavirus, including both SARS-CoV and SARS-Cov-2 that comprise a unique clade under the subgenus Sarbecovirus. The SARS-CoV-2 strains in India are more closely related to bat-CoVRaTG13 (93% homology) than pangolin CoV (83.5% homology). India reported its first case of Coronavirus Disease 19 (COVID-19) on January 30, 2020. Punjab, a state in northwestern India comprises of 22 districts which are classified into three major distinct regions viz. Majha, Malwa and Doaba. Four districts of Majha region of Indian state of Punjab are Amritsar, Tarn Taran, Gurdaspur and Pathankot. Aim: The present study describes the SARS-CoV-2 epidemiology based on samples tested for this virus;received at Viral Research and Diagnostic Laboratory (VRDL), Government Medical College, Amritsar-Punjab, India. Materials and Methods: This epidemiological study was designed taking into consideration three main factors i.e. the gender, the age groups and the factor whether the individual has any symptoms or not. To study their context of applicability
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Due to the imposing of the lockdown in India because of Covid-19, the boiler units in industries and power plants get shutdown. It leads to chances of occurrence of downtime corrosion in boilers. Generally, the downtime corrosion is said to be negligible as compare to corrosion that occurred during the working of boilers. However, if the shut down is longer than some weeks then this corrosion cannot be negligible at that level. It results in the loss of life of the material of the boiler and its parts. Thus this paper aims to point out the types of corrosion that can occur and preventive measures needed to be taken for the different types of downtime corrosion. © 2021 Author(s).