SLE patients have an increased burden of atherosclerosis leading to adverse cardiovascular events... more SLE patients have an increased burden of atherosclerosis leading to adverse cardiovascular events.Alterations in endothelial function, dysregulated immune system and increased oxidative stress are implicated in their development and progression. Carotid Artery Ultrasound has been recommended by the AHA/ACC to assess and follow progression of subclinical atherosclerosis & correlate with traditional /non traditional CV risk factors in SLE. To study the correlation between Carotid Intima Media Thickness, traditional/non traditional CV risk factors in SLE. Material: Hospital based descriptive, cross sectional study.Patients with Systemic Lupus Erythematosus, diagnosed by SLICC 2012 criteria, aged > 12 years, irrespective of therapy status, between April 2019 to August 2020, were recruited by consecutive sampling. Non consenting patients, individuals with preexisting cardiovascular disease, history of MACE, hypothyroidism (detected prior to diagnosis of SLE/disease onset), smokers, PLHIV,individuals with neck surgical, radiation, were excluded. Observation: 55 SLE patients were observed. No individuals were lost to follow up. Subgroup analysis was performed between SLE with Nephritis (36) and those without Nephritis (19) as presenting features. The mean age of the study subjects is 33 years with mean disease duration of 4.6 years.SLE nephritis patients had longer disease duration,younger age of disease onset & longer duration of steroid usage.The mean Systolic BP is 134+/-20mmHg, observed to be significantly higher in SLE nephritis patients. Framingham Risk scores were positively correlated with duration of SLE disease & SLEDAI 2K scores & duration of steroid therapy. The mean CIMT of the study population is 0.91mm with 10.9% plaque prevalence whereas Mean CIMT of Lupus nephritis patients is 1.02+/- 0.27mm; but no statistically significant difference in CIMT was observed between two subgroups. Carotid Intima Media thickness was positively correlated in bivariate analysis with anti DSDNA ab levels, Framingham Risk Scores,anaemia, SLE Disease activity scores, 24hr urine proteinuria,duration of steroid usage, Serum Creatinine & CRP. No correlation between CIMT and age of subjects,FPG,TG,serum homocysteine was observed. Conclusion: SLE patients have a high atherosclerosis burden and are at increased risk of adverse cardiovascular events. Carotid intima media thickness measurement by USG doppler is a reliable, non invasive, inexpensive tool which helps to detect subclinical atherosclerosis and plaques in SLE patients. In this study,Lupus Nephritis patients, Neuropsychiatric SLE and SLE with secondary APS, early age of lupus onset, longer disease duration with prolonged steroid therapy,significant proteinuria, higher antiDSDNA ab levels and hypocomplementemia are observed to have higher mean CIMT and plaque formation.
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, Apr 1, 2022
Coronavirus Disease -19 (Covid-19) is a global challenge due to its catastrophic impact on health... more Coronavirus Disease -19 (Covid-19) is a global challenge due to its catastrophic impact on healthcare demographics worldwide. Post Covid Syndrome is a new clinical entity that has emerged as a concern in recent times. It is dened as the presence of some persistent symptoms like fatigue, cognitive impairment and sleep disturbances in patients even after four weeks of recovery from Covid-19. Recent medical literature has hinted on Post-Covid vascular complications and our study has supplemented it by reporting new-onset hypertension in a series of eight patients within four weeks of recovery from laboratory proven Covid-19. None of the patients had pre-existing hypertension, cardiac disease, renal abnormalities or any history of long term steroid intake. These patients presented to the fever clinic with initial symptoms of fever, sore throat, mild cough and fatigue. `They were managed conservatively at home but one of the patients required hospital admission due to hypoxia.All the patients recovered within ten days of presentation and weekly follow-up visits were scheduled for six weeks at Post-Covid Recovery clinic. At the clinic, some of them complained of persistent headaches, occasional palpitations or prolonged fatigue. Examination incidentally revealed consistently elevated blood pressure in all the eight patients, even those who did not have any post covid symptoms. They were advised on antihypertensive drug therapy and lifestyle modications after six week of routine follow-up and home monitoring. It is proposed that the close binding of the virus with Angiotensin Converting Enzyme-2 (ACE2) can lead to decrease in the serum enzyme levels, which in turn inhibit the protective pathway of the Renin-Angiotensin-Aldosterone (RAAS) axis. It might lead to imprudent rise in Angiotensin-2 and thereby blood pressure. Hypertension and its concomitant effect on target organ damage is a well known risk factor for increased mortality and morbidity among hospitalized Covid-19 patients. The development of hypertension and other cardiovascular manifestations in the post covid-19 recovery phase warrants further research to understand the molecular mechanisms, early identication and timely intervention to reduce incidence of adverse cardiovascular events in such patient cohorts.
Coronavirus Disease -19 (Covid-19) is a global challenge due to its catastrophic impact on health... more Coronavirus Disease -19 (Covid-19) is a global challenge due to its catastrophic impact on healthcare demographics worldwide. Post Covid Syndrome is a new clinical entity that has emerged as a concern in recent times. It is dened as the presence of some persistent symptoms like fatigue, cognitive impairment and sleep disturbances in patients even after four weeks of recovery from Covid-19. Recent medical literature has hinted on Post-Covid vascular complications and our study has supplemented it by reporting new-onset hypertension in a series of eight patients within four weeks of recovery from laboratory proven Covid-19. None of the patients had pre-existing hypertension, cardiac disease, renal abnormalities or any history of long term steroid intake. These patients presented to the fever clinic with initial symptoms of fever, sore throat, mild cough and fatigue. `They were managed conservatively at home but one of the patients required hospital admission due to hypoxia.All the pa...
Journal of Association of Physicians of India, Apr 1, 2022
SLE patients have an increased burden of atherosclerosis leading to adverse cardiovascular events... more SLE patients have an increased burden of atherosclerosis leading to adverse cardiovascular events.Alterations in endothelial function, dysregulated immune system and increased oxidative stress are implicated in their development and progression. Carotid Artery Ultrasound has been recommended by the AHA/ACC to assess and follow progression of subclinical atherosclerosis & correlate with traditional /non traditional CV risk factors in SLE. To study the correlation between Carotid Intima Media Thickness, traditional/non traditional CV risk factors in SLE. MATERIAL Hospital based descriptive, cross sectional study.Patients with Systemic Lupus Erythematosus, diagnosed by SLICC 2012 criteria, aged > 12 years, irrespective of therapy status, between April 2019 to August 2020, were recruited by consecutive sampling. Non consenting patients, individuals with preexisting cardiovascular disease, history of MACE, hypothyroidism (detected prior to diagnosis of SLE/disease onset), smokers, PLHIV,individuals with neck surgical, radiation, were excluded. OBSERVATION 55 SLE patients were observed. No individuals were lost to follow up. Subgroup analysis was performed between SLE with Nephritis (36) and those without Nephritis (19) as presenting features. The mean age of the study subjects is 33 years with mean disease duration of 4.6 years.SLE nephritis patients had longer disease duration,younger age of disease onset & longer duration of steroid usage.The mean Systolic BP is 134+/-20mmHg, observed to be significantly higher in SLE nephritis patients. Framingham Risk scores were positively correlated with duration of SLE disease & SLEDAI 2K scores & duration of steroid therapy. The mean CIMT of the study population is 0.91mm with 10.9% plaque prevalence whereas Mean CIMT of Lupus nephritis patients is 1.02+/- 0.27mm; but no statistically significant difference in CIMT was observed between two subgroups. Carotid Intima Media thickness was positively correlated in bivariate analysis with anti DSDNA ab levels, Framingham Risk Scores,anaemia, SLE Disease activity scores, 24hr urine proteinuria,duration of steroid usage, Serum Creatinine & CRP. No correlation between CIMT and age of subjects,FPG,TG,serum homocysteine was observed. CONCLUSION SLE patients have a high atherosclerosis burden and are at increased risk of adverse cardiovascular events. Carotid intima media thickness measurement by USG doppler is a reliable, non invasive, inexpensive tool which helps to detect subclinical atherosclerosis and plaques in SLE patients. In this study,Lupus Nephritis patients, Neuropsychiatric SLE and SLE with secondary APS, early age of lupus onset, longer disease duration with prolonged steroid therapy,significant proteinuria, higher antiDSDNA ab levels and hypocomplementemia are observed to have higher mean CIMT and plaque formation.
Background: Chronic kidney disease (CKD) is associated with a substantial cardiovascular mortalit... more Background: Chronic kidney disease (CKD) is associated with a substantial cardiovascular mortality and morbidity. Besides other factors, accelerated atherosclerosis plays a significant role in this. Carotid intima media thickness (CIMT) is an index of systemic atherosclerosis. By measuring the CIMT with the help of B mode ultrasound at common carotid artery, the overall atherosclerotic burden in CKD patients can be estimated. Accordingly patients at increased risk of premature mortality can be identified so that timely intervention can be taken. Aims and Objectives: The aim of the study was to measure the CIMT at the level of common carotid artery by B mode ultrasound for estimation of atherosclerotic burden in patients with CKD. Materials and Methods: It is a hospital based observational cross-sectional study involving 70 patients carried out in the department of General Medicine of Medical College and Hospital, Kolkata for a period of 1 year. Patients were selected on the basis of...
International Journal of Research in Medical Sciences, 2020
Background: N-acetyl cysteine, a mucolytic agent, demonstrates free radical scavenging and anti-i... more Background: N-acetyl cysteine, a mucolytic agent, demonstrates free radical scavenging and anti-inflammatory properties, and prevents endothelial dysfunction by inhibition of NF-KB and formation of no adducts. This has a potential role to tackle cytokine storms, endothelial dysfunction and prothrombotic state observed in COVID-19 manifestations like ARDS and Multi organ dysfunction.Methods: Institution based descriptive cross sectional study, 164 patients from laboratory confirmed RT PCR positive COVID-19 patients, in the study period from 27th May 2020 to 10th August 2020, were assessed, in medical college Kolkata, a dedicated COVID-19 care facility.Results: It was observed that moderate-severe patients who received N-acetyl cysteine along with standard therapy had average hospital stay duration of 12 days, higher rate of discharge, average duration of oxygen therapy of 8 days, less number of deaths and reduced transfer to critical care facilities.Conclusions: N-acetyl cysteine can...
ABSTRACTObjectiveThis study will attempt to explore the demographic profile and outcome in the pa... more ABSTRACTObjectiveThis study will attempt to explore the demographic profile and outcome in the patients receiving multidisciplinary, personalised approach including use of Broad Spectrum Antivirals - Ivermectin, anti-inflammatory and antioxidants roles of Statins and N-acetyl-cysteine along with Standard of Care (SOC) in hospitalised COVID19 patients in a tertiary care centre.SettingInpatient departmentParticipants191 COVID-19 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the year 2020 between June 14-28, 2020Main outcome measuresThe outcome of Interests are:Studying the demographic profile of COVID 19 casesStudy the treatment outcomes in terms of death or discharge in patients receiving Ivermectin+N-acetyl-cysteine+Statin along with Standard of care.Results148 patients were included in the study. All of them had confirmed COVID19 infection by the rtPCR method. Average age of the patients was 57.57 years (Range = 17 - 8...
Orientia tsutsugumashi ( erstwhile Rickettsia tsutsugumashi) is an obligate intracellular bacteri... more Orientia tsutsugumashi ( erstwhile Rickettsia tsutsugumashi) is an obligate intracellular bacteria that is showing re-emergence in the last decade in eastern India 1-3. Commonly it causes acute febrile illness with rash and multiple organ involvement including CNS - In fact, Scrub encephalopathy has become a common cause of AES in recent times. Although pathogenesis of Scrub typhus is still uncertain, research on other Rickettsiales suggest infection of endothelial cells and vascular dysfunction to be the main mechanism. Based on that pathology we report two very rare manifestations - Acute Ischaemic Stroke and DVT in a single patient of Scrub typhus, occurring simultaneously. No such simultaneous occurrence has been reported in literature till date.
BackgroundWhile several trials are ongoing for treatment of COVID-19, scientific research on chem... more BackgroundWhile several trials are ongoing for treatment of COVID-19, scientific research on chemoprophylaxis is still lacking even though it has potential to delay the pandemic allowing us time to complete research on vaccines.MethodsWe have conducted a cohort study amongst Health Care Workers (HCW) exposed to COVID-19 patients, at a tertiary care center in India where there was an abrupt cluster outbreak within on duty personnel. HCWs who had voluntarily taken hydroxychloroquine (HCQ) prior to exposure were considered one cohort while those who had not were considered to be another. All participants with a verifiable contact history were tested for COVID-19 by rtPCR. The two cohorts were comparable in terms of age, gender, comorbidities and exposure. The primary outcome was incidence rates of rtPCR positive COVID-19 infection amongst HCQ users and non users.Results106 healthcare workers were examined in this cohort study of whom 54 were HCQ users and rest were not. The comparative...
A 23 year old female presented with acute onset paraparesis. She denied any history of fever, wei... more A 23 year old female presented with acute onset paraparesis. She denied any history of fever, weight loss or drenching night sweats. Neither did she have any obvious lymphadenopathy on general examination. Chest Xray was however suggestive of mediastinal widening and her MRI spine showed metastases with superior mediastinal SOL. Biopsy of this SOL ultimately revealed classical Hodgkin lymphoma. Thus this was a very unusual initial presentation of Hodgkin lymphoma presenting as Epidural Spinal Cord Compression. Hasenclever IPS score was 2. Patient was treated with radiotherapy followed by ABVD chemotherapy and achieved remission in 3months.
IntroductionTransplant centers hesitate to transplant patients with cognitive impairment. It is u... more IntroductionTransplant centers hesitate to transplant patients with cognitive impairment. It is unclear if pre‐kidney transplant (KT) cognitive screening can predict post‐KT cognitive function.MethodsWe evaluated pre‐ to post‐KT cognitive function with the Montreal Cognitive Assessment (MoCA) in a cohort of 108 patients. We used an adjusted logistic regression model to assess pre‐ to post‐KT changes in cognitive status (continuous variable) and a linear mixed model to assess changes in MoCA scores (categorical variable) pre‐ to post‐ KT.ResultsThe average pre‐ and post‐KT MoCA scores were 25.3 ± 3.0 and 26.4 ± 2.8, respectively. Final pre‐KT score did not predict post‐KT cognitive status (OR = 1.08; 95% CI: .92–1.26; P = .35). 32% of the patients with a final pre‐KT score ≥26 had at least one post‐KT score < 26. Conversely, 61% of the patients with a final pre‐KT score < 26 had at least one post KT score ≥26. In the linear mixed model analysis, the final pre‐KT score was associated with a small, clinically insignificant (β = .34; 95% CI: .19–.49; P < .001) effect on the post‐KT score.ConclusionA low pre‐KT MoCA score is not a strong independent predictor of post‐KT cognitive function and should not preclude patients from receiving a KT.
Background: Patients at the highest risk of hyperkalemia are those with chronic kidney disease (C... more Background: Patients at the highest risk of hyperkalemia are those with chronic kidney disease (CKD) stages 3 and 4. Objective: To evaluate the efficacy and safety of patiromer in hyperkalemia in patients with heart failure or CKD. Methods: The Cochrane Renal Group’s Specialized Register was searched through contact with the Trials’ Search Coordinator. We aimed at including randomized controlled trials with patiromer in patients with developed or risks of developing hyperkalemia, comparing against an active comparator or placebo. Three studies matched our inclusion and exclusion criteria, which we included in the meta-analysis. All-cause mortality, reduction in hospitalization, episodes of hypokalemia or hyperkalemia, and cardiovascular and gastrointestinal adverse events during the treatment period were our primary outcomes. Serial change in serum potassium (K+) until end of treatment or follow-up during the trial period and all other reported adverse reactions during the treatment...
SLE patients have an increased burden of atherosclerosis leading to adverse cardiovascular events... more SLE patients have an increased burden of atherosclerosis leading to adverse cardiovascular events.Alterations in endothelial function, dysregulated immune system and increased oxidative stress are implicated in their development and progression. Carotid Artery Ultrasound has been recommended by the AHA/ACC to assess and follow progression of subclinical atherosclerosis & correlate with traditional /non traditional CV risk factors in SLE. To study the correlation between Carotid Intima Media Thickness, traditional/non traditional CV risk factors in SLE. Material: Hospital based descriptive, cross sectional study.Patients with Systemic Lupus Erythematosus, diagnosed by SLICC 2012 criteria, aged > 12 years, irrespective of therapy status, between April 2019 to August 2020, were recruited by consecutive sampling. Non consenting patients, individuals with preexisting cardiovascular disease, history of MACE, hypothyroidism (detected prior to diagnosis of SLE/disease onset), smokers, PLHIV,individuals with neck surgical, radiation, were excluded. Observation: 55 SLE patients were observed. No individuals were lost to follow up. Subgroup analysis was performed between SLE with Nephritis (36) and those without Nephritis (19) as presenting features. The mean age of the study subjects is 33 years with mean disease duration of 4.6 years.SLE nephritis patients had longer disease duration,younger age of disease onset & longer duration of steroid usage.The mean Systolic BP is 134+/-20mmHg, observed to be significantly higher in SLE nephritis patients. Framingham Risk scores were positively correlated with duration of SLE disease & SLEDAI 2K scores & duration of steroid therapy. The mean CIMT of the study population is 0.91mm with 10.9% plaque prevalence whereas Mean CIMT of Lupus nephritis patients is 1.02+/- 0.27mm; but no statistically significant difference in CIMT was observed between two subgroups. Carotid Intima Media thickness was positively correlated in bivariate analysis with anti DSDNA ab levels, Framingham Risk Scores,anaemia, SLE Disease activity scores, 24hr urine proteinuria,duration of steroid usage, Serum Creatinine & CRP. No correlation between CIMT and age of subjects,FPG,TG,serum homocysteine was observed. Conclusion: SLE patients have a high atherosclerosis burden and are at increased risk of adverse cardiovascular events. Carotid intima media thickness measurement by USG doppler is a reliable, non invasive, inexpensive tool which helps to detect subclinical atherosclerosis and plaques in SLE patients. In this study,Lupus Nephritis patients, Neuropsychiatric SLE and SLE with secondary APS, early age of lupus onset, longer disease duration with prolonged steroid therapy,significant proteinuria, higher antiDSDNA ab levels and hypocomplementemia are observed to have higher mean CIMT and plaque formation.
INTERNATIONAL JOURNAL OF SCIENTIFIC RESEARCH, Apr 1, 2022
Coronavirus Disease -19 (Covid-19) is a global challenge due to its catastrophic impact on health... more Coronavirus Disease -19 (Covid-19) is a global challenge due to its catastrophic impact on healthcare demographics worldwide. Post Covid Syndrome is a new clinical entity that has emerged as a concern in recent times. It is dened as the presence of some persistent symptoms like fatigue, cognitive impairment and sleep disturbances in patients even after four weeks of recovery from Covid-19. Recent medical literature has hinted on Post-Covid vascular complications and our study has supplemented it by reporting new-onset hypertension in a series of eight patients within four weeks of recovery from laboratory proven Covid-19. None of the patients had pre-existing hypertension, cardiac disease, renal abnormalities or any history of long term steroid intake. These patients presented to the fever clinic with initial symptoms of fever, sore throat, mild cough and fatigue. `They were managed conservatively at home but one of the patients required hospital admission due to hypoxia.All the patients recovered within ten days of presentation and weekly follow-up visits were scheduled for six weeks at Post-Covid Recovery clinic. At the clinic, some of them complained of persistent headaches, occasional palpitations or prolonged fatigue. Examination incidentally revealed consistently elevated blood pressure in all the eight patients, even those who did not have any post covid symptoms. They were advised on antihypertensive drug therapy and lifestyle modications after six week of routine follow-up and home monitoring. It is proposed that the close binding of the virus with Angiotensin Converting Enzyme-2 (ACE2) can lead to decrease in the serum enzyme levels, which in turn inhibit the protective pathway of the Renin-Angiotensin-Aldosterone (RAAS) axis. It might lead to imprudent rise in Angiotensin-2 and thereby blood pressure. Hypertension and its concomitant effect on target organ damage is a well known risk factor for increased mortality and morbidity among hospitalized Covid-19 patients. The development of hypertension and other cardiovascular manifestations in the post covid-19 recovery phase warrants further research to understand the molecular mechanisms, early identication and timely intervention to reduce incidence of adverse cardiovascular events in such patient cohorts.
Coronavirus Disease -19 (Covid-19) is a global challenge due to its catastrophic impact on health... more Coronavirus Disease -19 (Covid-19) is a global challenge due to its catastrophic impact on healthcare demographics worldwide. Post Covid Syndrome is a new clinical entity that has emerged as a concern in recent times. It is dened as the presence of some persistent symptoms like fatigue, cognitive impairment and sleep disturbances in patients even after four weeks of recovery from Covid-19. Recent medical literature has hinted on Post-Covid vascular complications and our study has supplemented it by reporting new-onset hypertension in a series of eight patients within four weeks of recovery from laboratory proven Covid-19. None of the patients had pre-existing hypertension, cardiac disease, renal abnormalities or any history of long term steroid intake. These patients presented to the fever clinic with initial symptoms of fever, sore throat, mild cough and fatigue. `They were managed conservatively at home but one of the patients required hospital admission due to hypoxia.All the pa...
Journal of Association of Physicians of India, Apr 1, 2022
SLE patients have an increased burden of atherosclerosis leading to adverse cardiovascular events... more SLE patients have an increased burden of atherosclerosis leading to adverse cardiovascular events.Alterations in endothelial function, dysregulated immune system and increased oxidative stress are implicated in their development and progression. Carotid Artery Ultrasound has been recommended by the AHA/ACC to assess and follow progression of subclinical atherosclerosis & correlate with traditional /non traditional CV risk factors in SLE. To study the correlation between Carotid Intima Media Thickness, traditional/non traditional CV risk factors in SLE. MATERIAL Hospital based descriptive, cross sectional study.Patients with Systemic Lupus Erythematosus, diagnosed by SLICC 2012 criteria, aged > 12 years, irrespective of therapy status, between April 2019 to August 2020, were recruited by consecutive sampling. Non consenting patients, individuals with preexisting cardiovascular disease, history of MACE, hypothyroidism (detected prior to diagnosis of SLE/disease onset), smokers, PLHIV,individuals with neck surgical, radiation, were excluded. OBSERVATION 55 SLE patients were observed. No individuals were lost to follow up. Subgroup analysis was performed between SLE with Nephritis (36) and those without Nephritis (19) as presenting features. The mean age of the study subjects is 33 years with mean disease duration of 4.6 years.SLE nephritis patients had longer disease duration,younger age of disease onset & longer duration of steroid usage.The mean Systolic BP is 134+/-20mmHg, observed to be significantly higher in SLE nephritis patients. Framingham Risk scores were positively correlated with duration of SLE disease & SLEDAI 2K scores & duration of steroid therapy. The mean CIMT of the study population is 0.91mm with 10.9% plaque prevalence whereas Mean CIMT of Lupus nephritis patients is 1.02+/- 0.27mm; but no statistically significant difference in CIMT was observed between two subgroups. Carotid Intima Media thickness was positively correlated in bivariate analysis with anti DSDNA ab levels, Framingham Risk Scores,anaemia, SLE Disease activity scores, 24hr urine proteinuria,duration of steroid usage, Serum Creatinine & CRP. No correlation between CIMT and age of subjects,FPG,TG,serum homocysteine was observed. CONCLUSION SLE patients have a high atherosclerosis burden and are at increased risk of adverse cardiovascular events. Carotid intima media thickness measurement by USG doppler is a reliable, non invasive, inexpensive tool which helps to detect subclinical atherosclerosis and plaques in SLE patients. In this study,Lupus Nephritis patients, Neuropsychiatric SLE and SLE with secondary APS, early age of lupus onset, longer disease duration with prolonged steroid therapy,significant proteinuria, higher antiDSDNA ab levels and hypocomplementemia are observed to have higher mean CIMT and plaque formation.
Background: Chronic kidney disease (CKD) is associated with a substantial cardiovascular mortalit... more Background: Chronic kidney disease (CKD) is associated with a substantial cardiovascular mortality and morbidity. Besides other factors, accelerated atherosclerosis plays a significant role in this. Carotid intima media thickness (CIMT) is an index of systemic atherosclerosis. By measuring the CIMT with the help of B mode ultrasound at common carotid artery, the overall atherosclerotic burden in CKD patients can be estimated. Accordingly patients at increased risk of premature mortality can be identified so that timely intervention can be taken. Aims and Objectives: The aim of the study was to measure the CIMT at the level of common carotid artery by B mode ultrasound for estimation of atherosclerotic burden in patients with CKD. Materials and Methods: It is a hospital based observational cross-sectional study involving 70 patients carried out in the department of General Medicine of Medical College and Hospital, Kolkata for a period of 1 year. Patients were selected on the basis of...
International Journal of Research in Medical Sciences, 2020
Background: N-acetyl cysteine, a mucolytic agent, demonstrates free radical scavenging and anti-i... more Background: N-acetyl cysteine, a mucolytic agent, demonstrates free radical scavenging and anti-inflammatory properties, and prevents endothelial dysfunction by inhibition of NF-KB and formation of no adducts. This has a potential role to tackle cytokine storms, endothelial dysfunction and prothrombotic state observed in COVID-19 manifestations like ARDS and Multi organ dysfunction.Methods: Institution based descriptive cross sectional study, 164 patients from laboratory confirmed RT PCR positive COVID-19 patients, in the study period from 27th May 2020 to 10th August 2020, were assessed, in medical college Kolkata, a dedicated COVID-19 care facility.Results: It was observed that moderate-severe patients who received N-acetyl cysteine along with standard therapy had average hospital stay duration of 12 days, higher rate of discharge, average duration of oxygen therapy of 8 days, less number of deaths and reduced transfer to critical care facilities.Conclusions: N-acetyl cysteine can...
ABSTRACTObjectiveThis study will attempt to explore the demographic profile and outcome in the pa... more ABSTRACTObjectiveThis study will attempt to explore the demographic profile and outcome in the patients receiving multidisciplinary, personalised approach including use of Broad Spectrum Antivirals - Ivermectin, anti-inflammatory and antioxidants roles of Statins and N-acetyl-cysteine along with Standard of Care (SOC) in hospitalised COVID19 patients in a tertiary care centre.SettingInpatient departmentParticipants191 COVID-19 patients with laboratory confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in the year 2020 between June 14-28, 2020Main outcome measuresThe outcome of Interests are:Studying the demographic profile of COVID 19 casesStudy the treatment outcomes in terms of death or discharge in patients receiving Ivermectin+N-acetyl-cysteine+Statin along with Standard of care.Results148 patients were included in the study. All of them had confirmed COVID19 infection by the rtPCR method. Average age of the patients was 57.57 years (Range = 17 - 8...
Orientia tsutsugumashi ( erstwhile Rickettsia tsutsugumashi) is an obligate intracellular bacteri... more Orientia tsutsugumashi ( erstwhile Rickettsia tsutsugumashi) is an obligate intracellular bacteria that is showing re-emergence in the last decade in eastern India 1-3. Commonly it causes acute febrile illness with rash and multiple organ involvement including CNS - In fact, Scrub encephalopathy has become a common cause of AES in recent times. Although pathogenesis of Scrub typhus is still uncertain, research on other Rickettsiales suggest infection of endothelial cells and vascular dysfunction to be the main mechanism. Based on that pathology we report two very rare manifestations - Acute Ischaemic Stroke and DVT in a single patient of Scrub typhus, occurring simultaneously. No such simultaneous occurrence has been reported in literature till date.
BackgroundWhile several trials are ongoing for treatment of COVID-19, scientific research on chem... more BackgroundWhile several trials are ongoing for treatment of COVID-19, scientific research on chemoprophylaxis is still lacking even though it has potential to delay the pandemic allowing us time to complete research on vaccines.MethodsWe have conducted a cohort study amongst Health Care Workers (HCW) exposed to COVID-19 patients, at a tertiary care center in India where there was an abrupt cluster outbreak within on duty personnel. HCWs who had voluntarily taken hydroxychloroquine (HCQ) prior to exposure were considered one cohort while those who had not were considered to be another. All participants with a verifiable contact history were tested for COVID-19 by rtPCR. The two cohorts were comparable in terms of age, gender, comorbidities and exposure. The primary outcome was incidence rates of rtPCR positive COVID-19 infection amongst HCQ users and non users.Results106 healthcare workers were examined in this cohort study of whom 54 were HCQ users and rest were not. The comparative...
A 23 year old female presented with acute onset paraparesis. She denied any history of fever, wei... more A 23 year old female presented with acute onset paraparesis. She denied any history of fever, weight loss or drenching night sweats. Neither did she have any obvious lymphadenopathy on general examination. Chest Xray was however suggestive of mediastinal widening and her MRI spine showed metastases with superior mediastinal SOL. Biopsy of this SOL ultimately revealed classical Hodgkin lymphoma. Thus this was a very unusual initial presentation of Hodgkin lymphoma presenting as Epidural Spinal Cord Compression. Hasenclever IPS score was 2. Patient was treated with radiotherapy followed by ABVD chemotherapy and achieved remission in 3months.
IntroductionTransplant centers hesitate to transplant patients with cognitive impairment. It is u... more IntroductionTransplant centers hesitate to transplant patients with cognitive impairment. It is unclear if pre‐kidney transplant (KT) cognitive screening can predict post‐KT cognitive function.MethodsWe evaluated pre‐ to post‐KT cognitive function with the Montreal Cognitive Assessment (MoCA) in a cohort of 108 patients. We used an adjusted logistic regression model to assess pre‐ to post‐KT changes in cognitive status (continuous variable) and a linear mixed model to assess changes in MoCA scores (categorical variable) pre‐ to post‐ KT.ResultsThe average pre‐ and post‐KT MoCA scores were 25.3 ± 3.0 and 26.4 ± 2.8, respectively. Final pre‐KT score did not predict post‐KT cognitive status (OR = 1.08; 95% CI: .92–1.26; P = .35). 32% of the patients with a final pre‐KT score ≥26 had at least one post‐KT score < 26. Conversely, 61% of the patients with a final pre‐KT score < 26 had at least one post KT score ≥26. In the linear mixed model analysis, the final pre‐KT score was associated with a small, clinically insignificant (β = .34; 95% CI: .19–.49; P < .001) effect on the post‐KT score.ConclusionA low pre‐KT MoCA score is not a strong independent predictor of post‐KT cognitive function and should not preclude patients from receiving a KT.
Background: Patients at the highest risk of hyperkalemia are those with chronic kidney disease (C... more Background: Patients at the highest risk of hyperkalemia are those with chronic kidney disease (CKD) stages 3 and 4. Objective: To evaluate the efficacy and safety of patiromer in hyperkalemia in patients with heart failure or CKD. Methods: The Cochrane Renal Group’s Specialized Register was searched through contact with the Trials’ Search Coordinator. We aimed at including randomized controlled trials with patiromer in patients with developed or risks of developing hyperkalemia, comparing against an active comparator or placebo. Three studies matched our inclusion and exclusion criteria, which we included in the meta-analysis. All-cause mortality, reduction in hospitalization, episodes of hypokalemia or hyperkalemia, and cardiovascular and gastrointestinal adverse events during the treatment period were our primary outcomes. Serial change in serum potassium (K+) until end of treatment or follow-up during the trial period and all other reported adverse reactions during the treatment...
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Papers by Rishav Mukherjee