Tofacitinib as an Adjunct Immunomodulator for Treatment of a Patient with Severe COVID-19: A Case Report.

Severe coronavirus disease 2019 can be associated with progressive respiratory failure. In addition to respiratory support and other supportive care, use of corticosteroids has shown to improve outcome. Despite the use of steroids, a significant proportion of patients progressively worsen. Adjunct immunomodulators have been studied in addition to steroids in these patients. Here we present a successful use of tofacitinib, a Janus Kinase inhibitor, in conjunction with dexamethasone for a patient with rapid worsening of respiratory status and with high level of serum inflammatory biomarkers.

Right Ventricular Dimensions and Tricuspid Annular Plane Systolic Excursion among Medical Students of Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: The change in morphology and functions of the right ventricle is an important predictor of heart and lung disease. There is limited data on the normal dimension of the right ventricle. The study aimed to find the right ventricular diameter, its thickness, and tricuspid annular plane systolic excursion in healthy male medical students of a tertiary care hospital. METHODS: It is a descriptive cross-sectional study conducted in healthy medical students of Kathmandu Medical College and Teaching Hospital, from February-April, 2019. Ethical approval was taken from the institutional review committee (reference number 120720193). Convenient sampling method was used. We measured various dimensions of the right ventricle in different views. The data was analyzed in the Statistical Package for the Social Sciences. RESULTS: In the 96 male students included in the study, the mean right ventricular basal diameter was 36.45±3.49 mm, right ventricular mid cavity diameter was 29±3.63 mm, right ventricular longitudinal dimension was 65.72±7.52 mm, right ventricular outflow tract in parasternal long-axis view was 27.07±2.12 mm, proximal and distal right ventricular outflow in parasternal short-axis view was 25.33±2.57 mm and 20.08±1.99 mm, right ventricular thickness was 4.20±0.54 mm, and tricuspid annular plane systolic excursion was 23.02±3.54 mm. CONCLUSIONS: The study found that the values of right ventricular dimensions and the right ventricle's tricuspid annular plane systolic excursion among male medical students of a tertiary care hospital to be in accordance with the guidelines by the American Society of Echocardiography. The upper limits of the normal values of the right ventricle could be very helpful in clinical practice in determining the right ventricle dimension.

Vitamin D Deficiency among Patients Visiting a Tertiary Care Hospital: A Descriptive Cross-sectional Study.

INTRODUCTION: Vitamin D deficiency is a common condition prevalent among both developed and developing countries where it is seen mostly in females. It has been linked to various skeletal and non-skeletal diseases. This study was done to find out the prevalence of Vitamin D deficiency and clinical features of deficient patients attending the outpatient department of a tertiary care hospital. METHODS: This descriptive cross-sectional study was done among the patients attending the outpatient department of a tertiary care hospital in Kathmandu, Nepal. The study was conducted from May 2019 to July 2019. The ethical approval was taken from the Institutional Review Committee (ref no. 310520113). Convenient sampling was done. The collected data was entered in Microsoft Excel and was analyzed in the Statistical Package for the Social Sciences (SPSS) version 26. RESULTS: Out of 481 participants, the prevalence of vitamin D deficiency was 335 (69.6%). Severe vitamin D deficiency was seen in 78 (16.2%) and insufficient vitamin D in 77 (16%) of the patients. The mean serum vitamin D concentration by gender was 22.38±17.07 ng/ml in males and 18.89±15.25 ng/ml in females. A total of 263 (54.6%) females and 72 (14.97%) males had vitamin D deficiency. The most common symptoms found in vitamin D deficiency patients were fatigue 187(55.8%), muscle cramps 131(39.1%), generalized myalgia 125(37.31%), bone and joint pain 111(33.13%). CONCLUSIONS: Vitamin D deficiency was prevalent especially in females and elderly people. Fatigability was present in more than half of the vitamin D deficient patients.

Point-of-care ultrasonography of the orbit for detection of retinal detachment in a patient with hemolysis, elevated liver enzymes, and low platelet count syndrome.

Retinal detachment is a rare, but well-known cause of visual impairment in patients with hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. With supportive care, patients usually improve, with complete recovery of vision. Bedside ultrasonography of the orbit can be helpful for early detection of retinal detachment in these patients. Here, we present a case of HELLP syndrome presenting with severe visual symptoms. Retinal detachment was detected with point-of-care ocular sonography, which was confirmed with ophthalmoscopic examination. The patient was reassured of the favorable prognosis. Early initiation of aggressive supportive care was followed by progressive improvement of vision, which correlated with sonographic evidence of resolution of detachment. Her vision recovered completely in 2 weeks.