ABSTRACT
BACKGROUND: At 140 million, India has the second largest population of old people in the world, as per the 2011 census.1 The covid 19 pandemic has wreaked havoc in millions of lives. Elderly are especially vulnerable to COVID-19 and experience high morbidity and mortality as a result of immunosenescence. Age is independently linked with mortality, but age alone does not adequately capture the robustness of older adults who are a heterogeneous group. The current research was done in a tertiary healthcare hospital in Maharashtra to understand the clinical profile and factors that affected the outcome of elderly during the second wave of the COVID pandemic. METHOD: This was a single centre retrospective observational study done in a tertiary hospital which was admitting both covid and non-covid patients during the time of this study. All elderly patients admitted with COVID 19 disease in Covid ward and covid ICU (Intensive care unit) were included in the study. Their Demographic details, duration of illness, vital parameters, oxygen saturation, partial pressure of arterial oxygen compared to fraction of inspired oxygen (PaO2-FiO2 ratio) were recorded and also relevant investigations such as complete blood count, kidney function tests, liver function tests, arterial blood gases, chest X-rayand ECG (Electrocardiogram),CT scan of the brain, CSF(cerebrospinal fluid) studies and other tests where relevant were recorded. Inflammatory markers such as C-Reactive Protein (CRP), Ferritin, D-Dimer and Chest CT scan were noted. Clinical profiles and outcomes were noted till discharge or death. RESULTS: Among 231 patients that were included in this study, 81(35%) were female and 150 (65%) were male. Ninety-two patients died (39.8%) while 139 patients (60.2%) survived in our study. Majority of our patients (211;91.3%) presented in category E(pneumonia with respiratory failure) or category F(pneumonia with respiratory failure and multiorgan dysfunction syndrome). Factors which had a major impact on mortality were- a low PaO2-FiO2 ratio on admission, high C-Reactive Protein (CRP) levels, high d-dimer levels, a finding of bilateral ground glass opacities on x-ray, and need for invasive ventilation on admission. CONCLUSIONS: Elderly remain vulnerable to severe consequences of COVID-19 infection owing to the increasing comorbidities and immunosenescence in them. Prolonged oxygen therapy and intensive respiratory rehabilitation are the mainstays of effective management. Given the constant threat of mutating virus, masking, maintaining hand sanitization, vaccination and also caring for our elders while still maintaining social distance are our best bet against a fatal third wave.
Subject(s)
COVID-19 , Respiratory Insufficiency , Aged , C-Reactive Protein , Female , Humans , India/epidemiology , Male , Oxygen , Respiration, Artificial , SARS-CoV-2 , Tertiary Care CentersABSTRACT
We present the case of 36 yrs old female who presented with acute onset quadriparesis who was subsequently diagnosed to have Sjogrens syndrome with distal RTA with hypothyroidism.
Subject(s)
Acidosis, Renal Tubular/etiology , Sjogren's Syndrome/diagnosis , Adult , Female , Hashimoto Disease/complications , Hashimoto Disease/diagnosis , Humans , Hypothyroidism/etiology , Quadriplegia/etiology , Sjogren's Syndrome/complicationsABSTRACT
Here we report a case of VACTERL ASSOCIATION in a twenty three years old married female patient primigravida with 3 months of amenorrhea admitted with history of fever and gastroenteritis along with congenital developmental defects such as scoliosis (V), small ventricular septal defect (C), right sided hemifacial dysmorphic features (right mandibular hypoplasia), small sized right sided kidney (R), bilateral hypoplastic thumb (L). For the diagnosis of VACTERL atleast three out of seven anomalies should be present while our patient had four anomalies.
Subject(s)
Abnormalities, Multiple/diagnosis , Heart Defects, Congenital/diagnosis , Limb Deformities, Congenital/diagnosis , Pregnancy Complications/diagnosis , Amenorrhea/etiology , Anal Canal/abnormalities , Anal Canal/pathology , Echocardiography , Electrocardiography , Esophagus/abnormalities , Esophagus/pathology , Female , Heart Defects, Congenital/pathology , Humans , Kidney/abnormalities , Kidney/pathology , Limb Deformities, Congenital/pathology , Pregnancy , Pregnancy Complications/pathology , Pregnancy Trimester, Second , Spine/abnormalities , Spine/pathology , Trachea/abnormalities , Trachea/pathology , Treatment Outcome , Young AdultABSTRACT
Nephrotic syndrome, though common in children, association of it with Gitelman's syndrome (GS) is a rare occurrence. Very few cases have been reported in the medical literature so far. Here we report a case of nephrotic syndrome with frequent relapses and remissions on intermittent steroid and diuretic therapy. Patient was restarted on steroids and frusemide. Puffiness of face, bipedal edema and oliguria improved but patient developed tingling numbness in both limbs, perioral numbness and carpopedal spasm. On investigation she was found to have proteinuria, metabolic alkalosis, hypokalemia, hypocalcemia, hypomagnesemia and hyperreninemia with normal blood pressure.
