Background: Hypertension is leading and modifiable risk factor for cardiovascular diseases and al... more Background: Hypertension is leading and modifiable risk factor for cardiovascular diseases and all-cause mortality. Left ventricular hypertrophy, seen in hypertensive patients is a strong predictor of unfavourable cardiovascular events. Microalbuminuria is considered as principal predictor of cardiovascular complications and mortality. Our study aims at finding prevalence of increased urine albumin creatinine ratio and left ventricular mass index in newly diagnosed hypertensive patients and finding a correlation among them. Methodology: A hospital based cross sectional study was done. Adult patients visiting hospital OPD were screened for primary hypertension as per AHA (2017) guidelines and 40 were included in study. All patients underwent relevant blood and urine investigations. Urine albumin creatinine ratio was calculated in spot urine sample and left ventricular mass index was calculated using 2-D echocardiography. Result: This study demonstrated that 70% newly diagnosed hypert...
Background: Diabetes is a chronic metabolic disorder and has become the one of the most challengi... more Background: Diabetes is a chronic metabolic disorder and has become the one of the most challenging global health problem of 21 st centuary. Diabetic nephropathy is a major complication of diabetes and an established risk factor for cardiovascular events. Lipid abnormalities occur in patients with diabetic nephropathy, which further increase their risk for cardiovascular events. We aimed to research association between extended lipid profile and urine albumin-creatinine ratio (UACR), hypothesizing that early detection and treatment of lipid abnormalities can minimize the risk for atherogenic cardiovascular disorder and cerebrovascular accident in patients with type 2 diabetes mellitus. Methods: A hospital based cross- sectional study was conducted on 48 patients with type 2 diabetes mellitus. All patients fasting blood glucose (FBG), HbA1c, total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG), apolipoprotein-A (apo-A), apolipoprote...
In a brief span of time, coronavirus has become a major cause of concern worldwide ever since the... more In a brief span of time, coronavirus has become a major cause of concern worldwide ever since the first case was reported in Wuhan, China in December 2019. The pace at which the virus is being transmitted across the globe and the sudden increase in numbers of cases is much faster than severe acute respiratory syndrome and Middle East respiratory syndrome. With the rising number of cases, coronavirus disease 2019 (COVID-19) not only has an adverse effect on health, it has a deep seated impact on the economic and social front. Hence, the development of an effective vaccination strategy seems to be the only light at the end of the tunnel. The ongoing pandemic mandates the speedy evaluation of multiple approaches in order to elicit protective immunity and to curtail unwanted immune-potentiation which plays an important role in the pathogenesis of this virus. Being developed by more than 90 institutions in the world, a vaccine which is both effective and safe becomes all the more essential in the current time. Various types of vaccine strategies are being tested under different phases of clinical trials. The present paper hopes to provide an overview of the current work going on in this direction, with an aim to further fuel effects for an early and effective COVID-19 vaccine platform.
The Journal of the Association of Physicians of India, 2020
Coronavirus disease 2019 (COVID-19), causes serious respiratory illness manifesting as pneumonia,... more Coronavirus disease 2019 (COVID-19), causes serious respiratory illness manifesting as pneumonia, adult respiratory distress syndrome and respiratory failure. Amidst the rising number of cases and deaths, it is imperative to not forget Tuberculosis (TB) which is another pandemic existing since centuries. There could be dire consequences for tuberculosis patients globally especially in low and middle income countries with a high burden of disease and overwhelmed health care systems. Tuberculosis is still the leading infectious killer worldwide, and therefore, it is crucial to reflect on the interaction between the two diseases. Evidence suggests that both COVID-19 and tuberculosis have a synergistic relationship, boosting detrimental effect of each other, disrupting existing health care models, and also worsening the clinical outcomes in terms of morbidity and mortality. This review aims to draw attention towards this pertinent clinical issue, and tries to unravel the intricate relat...
In this study, a combination of clinical and hematological information, collected on day of prese... more In this study, a combination of clinical and hematological information, collected on day of presentation to the hospital with pneumonia, was evaluated for its ability to predict severity and mortality outcomes in COVID-19. Ours is a retrospective, observational study of 203 hospitalized COVID-19 patients. All of them were confirmed RT-PCR positive cases. We used simple hematological parameters (total leukocyte count, absolute neutrophil count, absolute lymphocyte count, neutrophil to lymphocyte ration and platelet to lymphocyte ratio); and a severity classification of pneumonia (mild, moderate and severe) based on a single clinical parameter, the percentage saturation of oxygen at room air, to predict the outcome in these cases. The results show that a high absolute neutrophil count on day of onset of pneumonia symptoms correlated strongly with both severity and survival in COVID-19. In addition, it was the primary driver of an initial high neutrophil-to-lymphocyte ratio (NLR) obser...
A 55-year-old female presented to the emergency department with maculopapular rashes involving wh... more A 55-year-old female presented to the emergency department with maculopapular rashes involving whole body following administration of intravenous artesunate for an acute febrile illness. Leukocytoclastic vasculitis (LCV) was diagnosed with the help of a biopsy, and causes for the condition other than drug induced were investigated and ruled out. Almost 10% of the LCV cases are caused by drugs; however, a literature search did not reveal any documented case of Artesunate-induced vasculitis. We suggest that patients on Artesunate therapy should be monitored for signs and symptoms of LCV.
Objective To investigate the effectiveness of using convalescent plasma to treat moderate coronav... more Objective To investigate the effectiveness of using convalescent plasma to treat moderate coronavirus disease 2019 (covid-19) in adults in India. Design Open label, parallel arm, phase II, multicentre, randomised controlled trial. Setting 39 public and private hospitals across India. Participants 464 adults (≥18 years) admitted to hospital (screened 22 April to 14 July 2020) with confirmed moderate covid-19 (partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO 2 /FiO 2 ) ratio between 200 mm Hg and 300 mm Hg or a respiratory rate of more than 24/min with oxygen saturation 93% or less on room air): 235 were assigned to convalescent plasma with best standard of care (intervention arm) and 229 to best standard of care only (control arm). Interventions Participants in the intervention arm received two doses of 200 mL convalescent plasma, transfused 24 hours apart. The presence and levels of neutralising antibodies were not measured a priori; stored samples were ...
Lipids play a critical role in pathogenesis of macrovascular complications of diabetes. Pre-diabe... more Lipids play a critical role in pathogenesis of macrovascular complications of diabetes. Pre-diabetes also been shown to be associated with increased risk of atherosclerosis. This study was planned to compare lipid profiles of pre-diabetes and diabetes. Total 60 cases were taken (30 Pre-diabetic and 30 Diabetic). Diabetics and pre-diabetics who met the criteria(for pre-diabetes FBS>100 to 125mg/dl and PPBS>140 to 199mg/dl,HbA1c 5.7 to 6.5%, for diabetes, FBS>125mg/dl and PPBS>200mg/dl,HbA1c>6.5%). The fasting total cholesterol and triglyceride level of two groups were compared. The mean value of total cholesterol were-Prediabetics-170.57± 26.18mg/dl and diabetics 171.23± 33.79mg/dl , which was statistically not significant(p=0.746).The fasting value of triglyceride in pre-diabetics was 131.1± 29.36mg/dl and in diabetics 164.950± 73 mg/dl which is statistically significant(p<0.01).Thus we concluded that as pre-diabetes progress to diabetes ,the fasting triglyceride l...
SARS-CoV-2, the causative agent for COVID-19, originated in China in the fall of 2019 and soon be... more SARS-CoV-2, the causative agent for COVID-19, originated in China in the fall of 2019 and soon became a pandemic engulfing the entire world, presenting with a myriad of presentations from asymptomatic to severe disease with acute respiratory distress syndrome and multiple organ dysfunction and severe inflammatory response. Little is understood about the new virus and its pathogenesis, and it is too early to ascertain its long-term sequelae at this point in time. New associations and clinical problems keep appearing with the new virus and thus we also got to encounter three cases of acute inflammatory demyelinating polyneuropathy (AIDP) in patients following COVID-19 infection. This case series aims to convey clinicians that AIDP can be seen in patients with COVID-19, particularly during the recovery phase, and thus not to miss it as postviral fatigue and malaise.
The Journal of the Association of Physicians of India, 2017
W read with interest the original a r t i c l e “ L i p i d P r o f i l e i n Prediabetes” by Sub... more W read with interest the original a r t i c l e “ L i p i d P r o f i l e i n Prediabetes” by Suboth Kansal and TK Kamble,1 March 2016,Vol 64,issue of journal of the association of physician of india.We did a similar study in which patterns of lipid profile in prediabetic and diabetics were compared. Total 60 cases were taken (30 Pre-diabetic and 30 Diabetic). Pre-Diabetics and Diabetics who met the criteria (for pre-diabetes FBS >100 to 125 mg/dl and PPBS >140 to 199mg/dl, HbA1c 5.7 to 6.4% and for diabetes, FBS≥126mg/dl and PPBS ≥200mg/dl, HbA1c ≥6.5%). The fasting total cholesterol and triglyceride level of two groups were compared. The mean value of total cholesterol in Prediabetics was-170.57 ± 26.18 mg/dl and diabetics was 171.23 ± 33.79 mg/dl, which was statistically not significant (p=0.746). While the fasting value of triglyceride in pre-diabetics was 131.1 ± 29.36mg/dl and in diabetics 164.950±73 mg/dl which was statistically significant (p<0.01). Thus we conclude...
Renal stones are a common condition causing significant morbidity and economic burden. The preval... more Renal stones are a common condition causing significant morbidity and economic burden. The prevalence of urinary tract stones in the developed nations ranges from 4–20%. Renal stones are of different types, the most common being the calcium oxalate stones. Various dietary, non-dietary, and urinary risk factors contribute to their formation. Their frequent association with systemic diseases (like hypertension, diabetes, and obesity) highlights the role of dietary and lifestyle changes in their occurrence, recurrence, and possible prevention. Non-contrast computed tomography (CT) identifies almost every stone and is the preferred investigation for identification. Ultrasound has its advantages, as it is low cost and requires no radiation, but is observer dependent. Metabolic profiles (including blood calcium, phosphate, magnesium, creatinine, uric acid, sodium, and potassium) should be measured and a detailed urinalysis should be done. This review further discusses the formation in dep...
Background and Aim Coronavirus disease 2019 (COVID 2019) outbreak caused by severe acute respirat... more Background and Aim Coronavirus disease 2019 (COVID 2019) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may cause multisystem dysfunction. We studied pancreatic injury (serum amylase and serum lipase levels) in COVID-19 patients. Methods A retrospective study involving 42 COVID-19 patients (diagnosed by real-time PCR) admitted to a tertiary care hospital was conducted. Serum amylase and serum lipase levels were analysed in relation to severity of COVID-19 and mortality. Results Mean age of patients was 50 ± 16 years, with male to female ratio of 3.7:1. Serum amylase was elevated in 14 patients (33%). Serum lipase was elevated in 7 out of 29 patients (24.1%). Mortality was seen in 18 patients (42.8%). Serum amylase or lipase did not correlate with severity of COVID-19 or its mortality. However, both patients who had high lipase (>3times) died. Conclusion The prevalence of hyperamylasemia in patients of COVID-19 was 33%, while that of elevated lipas...
Meningococcal outbreaks are a major health concern in Delhi and adjoining regions. Besides acute ... more Meningococcal outbreaks are a major health concern in Delhi and adjoining regions. Besides acute pyogenic meningitis, meningococcal disease can also manifest as vasculitis, dermatitis and arthritis. To study the frequency, characteristics and long-term outcome of joint involvement in May 2005 meningococcal outbreak in New Delhi, 24 patients with proven meningococcal disease admitted to the hospital from May, 2005 through August, 2005 were studied for occurrence and outcome of joint involvement, and were followed up and evaluated for any complications. The frequency of arthritis was found to be 20%, which is much higher than reported. Diplococci could be identified in the joint aspirate of all 5 patients who developed arthritis. All patients had features of acute septic arthritis which healed without residual deformity following arthrotomy. A significant percentage of patients can still be expected to develop acute septic arthritis in an outbreak of meningococcal meningitis, and a hi...
Background: Hypertension is leading and modifiable risk factor for cardiovascular diseases and al... more Background: Hypertension is leading and modifiable risk factor for cardiovascular diseases and all-cause mortality. Left ventricular hypertrophy, seen in hypertensive patients is a strong predictor of unfavourable cardiovascular events. Microalbuminuria is considered as principal predictor of cardiovascular complications and mortality. Our study aims at finding prevalence of increased urine albumin creatinine ratio and left ventricular mass index in newly diagnosed hypertensive patients and finding a correlation among them. Methodology: A hospital based cross sectional study was done. Adult patients visiting hospital OPD were screened for primary hypertension as per AHA (2017) guidelines and 40 were included in study. All patients underwent relevant blood and urine investigations. Urine albumin creatinine ratio was calculated in spot urine sample and left ventricular mass index was calculated using 2-D echocardiography. Result: This study demonstrated that 70% newly diagnosed hypert...
Background: Diabetes is a chronic metabolic disorder and has become the one of the most challengi... more Background: Diabetes is a chronic metabolic disorder and has become the one of the most challenging global health problem of 21 st centuary. Diabetic nephropathy is a major complication of diabetes and an established risk factor for cardiovascular events. Lipid abnormalities occur in patients with diabetic nephropathy, which further increase their risk for cardiovascular events. We aimed to research association between extended lipid profile and urine albumin-creatinine ratio (UACR), hypothesizing that early detection and treatment of lipid abnormalities can minimize the risk for atherogenic cardiovascular disorder and cerebrovascular accident in patients with type 2 diabetes mellitus. Methods: A hospital based cross- sectional study was conducted on 48 patients with type 2 diabetes mellitus. All patients fasting blood glucose (FBG), HbA1c, total cholesterol (TC), high density lipoprotein (HDL), low density lipoprotein (LDL), triglyceride (TG), apolipoprotein-A (apo-A), apolipoprote...
In a brief span of time, coronavirus has become a major cause of concern worldwide ever since the... more In a brief span of time, coronavirus has become a major cause of concern worldwide ever since the first case was reported in Wuhan, China in December 2019. The pace at which the virus is being transmitted across the globe and the sudden increase in numbers of cases is much faster than severe acute respiratory syndrome and Middle East respiratory syndrome. With the rising number of cases, coronavirus disease 2019 (COVID-19) not only has an adverse effect on health, it has a deep seated impact on the economic and social front. Hence, the development of an effective vaccination strategy seems to be the only light at the end of the tunnel. The ongoing pandemic mandates the speedy evaluation of multiple approaches in order to elicit protective immunity and to curtail unwanted immune-potentiation which plays an important role in the pathogenesis of this virus. Being developed by more than 90 institutions in the world, a vaccine which is both effective and safe becomes all the more essential in the current time. Various types of vaccine strategies are being tested under different phases of clinical trials. The present paper hopes to provide an overview of the current work going on in this direction, with an aim to further fuel effects for an early and effective COVID-19 vaccine platform.
The Journal of the Association of Physicians of India, 2020
Coronavirus disease 2019 (COVID-19), causes serious respiratory illness manifesting as pneumonia,... more Coronavirus disease 2019 (COVID-19), causes serious respiratory illness manifesting as pneumonia, adult respiratory distress syndrome and respiratory failure. Amidst the rising number of cases and deaths, it is imperative to not forget Tuberculosis (TB) which is another pandemic existing since centuries. There could be dire consequences for tuberculosis patients globally especially in low and middle income countries with a high burden of disease and overwhelmed health care systems. Tuberculosis is still the leading infectious killer worldwide, and therefore, it is crucial to reflect on the interaction between the two diseases. Evidence suggests that both COVID-19 and tuberculosis have a synergistic relationship, boosting detrimental effect of each other, disrupting existing health care models, and also worsening the clinical outcomes in terms of morbidity and mortality. This review aims to draw attention towards this pertinent clinical issue, and tries to unravel the intricate relat...
In this study, a combination of clinical and hematological information, collected on day of prese... more In this study, a combination of clinical and hematological information, collected on day of presentation to the hospital with pneumonia, was evaluated for its ability to predict severity and mortality outcomes in COVID-19. Ours is a retrospective, observational study of 203 hospitalized COVID-19 patients. All of them were confirmed RT-PCR positive cases. We used simple hematological parameters (total leukocyte count, absolute neutrophil count, absolute lymphocyte count, neutrophil to lymphocyte ration and platelet to lymphocyte ratio); and a severity classification of pneumonia (mild, moderate and severe) based on a single clinical parameter, the percentage saturation of oxygen at room air, to predict the outcome in these cases. The results show that a high absolute neutrophil count on day of onset of pneumonia symptoms correlated strongly with both severity and survival in COVID-19. In addition, it was the primary driver of an initial high neutrophil-to-lymphocyte ratio (NLR) obser...
A 55-year-old female presented to the emergency department with maculopapular rashes involving wh... more A 55-year-old female presented to the emergency department with maculopapular rashes involving whole body following administration of intravenous artesunate for an acute febrile illness. Leukocytoclastic vasculitis (LCV) was diagnosed with the help of a biopsy, and causes for the condition other than drug induced were investigated and ruled out. Almost 10% of the LCV cases are caused by drugs; however, a literature search did not reveal any documented case of Artesunate-induced vasculitis. We suggest that patients on Artesunate therapy should be monitored for signs and symptoms of LCV.
Objective To investigate the effectiveness of using convalescent plasma to treat moderate coronav... more Objective To investigate the effectiveness of using convalescent plasma to treat moderate coronavirus disease 2019 (covid-19) in adults in India. Design Open label, parallel arm, phase II, multicentre, randomised controlled trial. Setting 39 public and private hospitals across India. Participants 464 adults (≥18 years) admitted to hospital (screened 22 April to 14 July 2020) with confirmed moderate covid-19 (partial pressure of oxygen in arterial blood/fraction of inspired oxygen (PaO 2 /FiO 2 ) ratio between 200 mm Hg and 300 mm Hg or a respiratory rate of more than 24/min with oxygen saturation 93% or less on room air): 235 were assigned to convalescent plasma with best standard of care (intervention arm) and 229 to best standard of care only (control arm). Interventions Participants in the intervention arm received two doses of 200 mL convalescent plasma, transfused 24 hours apart. The presence and levels of neutralising antibodies were not measured a priori; stored samples were ...
Lipids play a critical role in pathogenesis of macrovascular complications of diabetes. Pre-diabe... more Lipids play a critical role in pathogenesis of macrovascular complications of diabetes. Pre-diabetes also been shown to be associated with increased risk of atherosclerosis. This study was planned to compare lipid profiles of pre-diabetes and diabetes. Total 60 cases were taken (30 Pre-diabetic and 30 Diabetic). Diabetics and pre-diabetics who met the criteria(for pre-diabetes FBS>100 to 125mg/dl and PPBS>140 to 199mg/dl,HbA1c 5.7 to 6.5%, for diabetes, FBS>125mg/dl and PPBS>200mg/dl,HbA1c>6.5%). The fasting total cholesterol and triglyceride level of two groups were compared. The mean value of total cholesterol were-Prediabetics-170.57± 26.18mg/dl and diabetics 171.23± 33.79mg/dl , which was statistically not significant(p=0.746).The fasting value of triglyceride in pre-diabetics was 131.1± 29.36mg/dl and in diabetics 164.950± 73 mg/dl which is statistically significant(p<0.01).Thus we concluded that as pre-diabetes progress to diabetes ,the fasting triglyceride l...
SARS-CoV-2, the causative agent for COVID-19, originated in China in the fall of 2019 and soon be... more SARS-CoV-2, the causative agent for COVID-19, originated in China in the fall of 2019 and soon became a pandemic engulfing the entire world, presenting with a myriad of presentations from asymptomatic to severe disease with acute respiratory distress syndrome and multiple organ dysfunction and severe inflammatory response. Little is understood about the new virus and its pathogenesis, and it is too early to ascertain its long-term sequelae at this point in time. New associations and clinical problems keep appearing with the new virus and thus we also got to encounter three cases of acute inflammatory demyelinating polyneuropathy (AIDP) in patients following COVID-19 infection. This case series aims to convey clinicians that AIDP can be seen in patients with COVID-19, particularly during the recovery phase, and thus not to miss it as postviral fatigue and malaise.
The Journal of the Association of Physicians of India, 2017
W read with interest the original a r t i c l e “ L i p i d P r o f i l e i n Prediabetes” by Sub... more W read with interest the original a r t i c l e “ L i p i d P r o f i l e i n Prediabetes” by Suboth Kansal and TK Kamble,1 March 2016,Vol 64,issue of journal of the association of physician of india.We did a similar study in which patterns of lipid profile in prediabetic and diabetics were compared. Total 60 cases were taken (30 Pre-diabetic and 30 Diabetic). Pre-Diabetics and Diabetics who met the criteria (for pre-diabetes FBS >100 to 125 mg/dl and PPBS >140 to 199mg/dl, HbA1c 5.7 to 6.4% and for diabetes, FBS≥126mg/dl and PPBS ≥200mg/dl, HbA1c ≥6.5%). The fasting total cholesterol and triglyceride level of two groups were compared. The mean value of total cholesterol in Prediabetics was-170.57 ± 26.18 mg/dl and diabetics was 171.23 ± 33.79 mg/dl, which was statistically not significant (p=0.746). While the fasting value of triglyceride in pre-diabetics was 131.1 ± 29.36mg/dl and in diabetics 164.950±73 mg/dl which was statistically significant (p<0.01). Thus we conclude...
Renal stones are a common condition causing significant morbidity and economic burden. The preval... more Renal stones are a common condition causing significant morbidity and economic burden. The prevalence of urinary tract stones in the developed nations ranges from 4–20%. Renal stones are of different types, the most common being the calcium oxalate stones. Various dietary, non-dietary, and urinary risk factors contribute to their formation. Their frequent association with systemic diseases (like hypertension, diabetes, and obesity) highlights the role of dietary and lifestyle changes in their occurrence, recurrence, and possible prevention. Non-contrast computed tomography (CT) identifies almost every stone and is the preferred investigation for identification. Ultrasound has its advantages, as it is low cost and requires no radiation, but is observer dependent. Metabolic profiles (including blood calcium, phosphate, magnesium, creatinine, uric acid, sodium, and potassium) should be measured and a detailed urinalysis should be done. This review further discusses the formation in dep...
Background and Aim Coronavirus disease 2019 (COVID 2019) outbreak caused by severe acute respirat... more Background and Aim Coronavirus disease 2019 (COVID 2019) outbreak caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may cause multisystem dysfunction. We studied pancreatic injury (serum amylase and serum lipase levels) in COVID-19 patients. Methods A retrospective study involving 42 COVID-19 patients (diagnosed by real-time PCR) admitted to a tertiary care hospital was conducted. Serum amylase and serum lipase levels were analysed in relation to severity of COVID-19 and mortality. Results Mean age of patients was 50 ± 16 years, with male to female ratio of 3.7:1. Serum amylase was elevated in 14 patients (33%). Serum lipase was elevated in 7 out of 29 patients (24.1%). Mortality was seen in 18 patients (42.8%). Serum amylase or lipase did not correlate with severity of COVID-19 or its mortality. However, both patients who had high lipase (>3times) died. Conclusion The prevalence of hyperamylasemia in patients of COVID-19 was 33%, while that of elevated lipas...
Meningococcal outbreaks are a major health concern in Delhi and adjoining regions. Besides acute ... more Meningococcal outbreaks are a major health concern in Delhi and adjoining regions. Besides acute pyogenic meningitis, meningococcal disease can also manifest as vasculitis, dermatitis and arthritis. To study the frequency, characteristics and long-term outcome of joint involvement in May 2005 meningococcal outbreak in New Delhi, 24 patients with proven meningococcal disease admitted to the hospital from May, 2005 through August, 2005 were studied for occurrence and outcome of joint involvement, and were followed up and evaluated for any complications. The frequency of arthritis was found to be 20%, which is much higher than reported. Diplococci could be identified in the joint aspirate of all 5 patients who developed arthritis. All patients had features of acute septic arthritis which healed without residual deformity following arthrotomy. A significant percentage of patients can still be expected to develop acute septic arthritis in an outbreak of meningococcal meningitis, and a hi...
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