Background: The cytokine cascade in COVID-19 is responsible for its clinical manifestations. Timely management of patients with dismal prognosis may improve their clinical outcome. The study aimed to analyze the hematological and biochemical parameters among COVID-19 patients and the factors associated with laboratory changes and COVID-19 infection. Materials and Methods: A retrospective, cross-sectional study was conducted in a designated district COVID hospital. COVID-19 patient’s medical records were converted into an electronic database which included demographic data, recent exposure history, existing co-morbidities, symptoms, and laboratory findings. Results: Out of the 1340 patients, 69.25% were males. Symptomatics accounted for 57.61%. The common co-morbidities among infected patients were diabetes mellitus (13.88%), hypertension (15%), and chronic obstructive pulmonary disease/asthma (2.16%), which had a significant positive correlation with COVID-19. The common symptoms were fever (50.39%), dry cough (46.24%), dyspnea (30.7%), and myalgia (28.5%). Leucocytosis, neutrophilia, lymphopenia, and thrombocytopenia were reported in 5.22%, 11.34%, 27.16%, and 3.41% of patients, respectively. Elevated aspartate aminotransferase, alanine aminotransferase, hypoalbuminemia, and hyperglobulinemia were observed in 13.88%, 19.4%, 24.77%, and 10% of patients, respectively. Symptomatics had significantly higher values for neutrophil percentage, neutrophil–lymphocyte ratio (NLR), derived NLR, lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio, lymphocyte–leucocyte ratio, systemic immune-inflammatory index, blood urea, and indirect bilirubin levels and significantly lower values for lymphocyte percentage, absolute lymphocyte count, and serum albumin. The logistic regression analysis revealed a significant association of deranged laboratory parameters among symptomatic COVID-19 patients and those with pre-existing co-morbidities. Conclusion: Neutrophilia, lymphopenia, and deranged liver function tests were significantly present in COVID-19 patients. The inflammation in COVID-19 is exhibited as remarkable hematological and laboratory changes whose careful interpretation can offer a clinical window for risk stratification and appropriate therapeutic interventions.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Aim: To analyze the impact of corona virus disease-19 (COVID-19) pandemic and various containment measures taken for the pandemic control on hospital admissions of acute coronary syndrome (ACS). Materials and Methods: This study is a single-center, comparative study conducted at a tertiary care center situated in the southern part of India. The study period was from March 1, 2020 till May 31, 2020, including the first lockdown period in India. All patients admitted with a diagnosis of ACS to our hospital during the study period were included in the study (study group). This group was compared with the patients admitted with ACS into our hospital during the corresponding period of the previous year (control group). Patients with ST-elevation myocardial infarction (STEMI) were compared with the control group for clinical profile, treatment, hospital course, outcome, and incidence rate ratio (IRR) of admissions. Results: There was a significant reduction of mean daily admissions of ACS cases in the study group with IRR of 0.702; 95% confidence interval (CI), 0.719–1.02; P < 0.001. The reduction rate of ACS cases was 29.74% (study period, n = 215; control period, n = 306), and it was mostly related to a decline in the number of non-ST-elevation myocardial infarction (NSTEMI) and unstable angina. No significant reduction of patients with STEMI was observed between the groups. However, patients with STEMI had more left ventricular (LV) dysfunction, LV thrombus, and a significantly higher incidence of mitral regurgitation (13.3% vs. 8.8%, P < 0.05). The impact of the COVID-19 outbreak on the patients with ACS revealed a parallel reduction of hospital admissions with an increasing number of COVID-19 cases in the community. Conclusion: The COVID-19 pandemic and concomitant social restrictions resulted in a significant decline in hospital admissions due to ACS in this tertiary care center, but without any effect on the number of admissions with STEMI. A parallel reduction of hospital admissions for ACS cases with a rising number of COVID-19 cases in the community was also observed in this study.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Context: The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, in December 2019. The management plan is supportive care with oxygen supplementation and mechanical ventilation. US FDA approved convalescent plasma (CP) for COVID-19 for clinical trials and as an emergency investigational new drug. Although numerous trials are currently investigating the safety and efficacy of CP in COVID-19 patients, there is a paucity of ongoing and published studies evaluating the CP donors’ side. This retrospective study reports the CP donors’ selection and deferrals. Aim: To evaluate and analyze the donor deferral pattern and its causes among CP donors in a tertiary care hospital blood bank apheresis unit. Settings and Design: Hospital-based retrospective analysis. Subjects and Methods: Donors aged 18–65 years who had recovered from COVID-19 at least 4 weeks previously coming for plasma donation were retrospectively analyzed from July 25, 2020 to January 24, 2021 for a period of 6 months at blood bank apheresis unit, Assam Medical College and Hospital. Results: A total of 396 potential plasma donors were screened during the study period. The donor deferral rate was 39.1%. The permanent deferral was 36.8%, and the temporary deferral was 63.2%. The maximum number of donors deferred because of low antibody (18.7%) followed by low hemoglobin (14.8%). Associated comorbidities, low platelet count, repeat reverse transcription-polymerase chain reaction positivity, transfusion transmitted infection reactivity, intake of medicines, infections, vaccination, and underweight were other causes identified. Conclusion: The pattern of donor deferral is an important tool for blood safety and also provides key areas to focus on a demographic region or policy formulation for donor selection as well as to ensure donor safety.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: The burden of antimicrobial resistance (AMR) is increasing globally at an alarming rate, especially among hospitalized cases. However, there is still lack of knowledge about morbidity and mortality due to AMR infections among different populations. The present study was aimed to provide a brief insight on the prevalence of AMR infection among the patients attending Assam Medical College and Hospital, Dibrugarh, Assam, India. Materials and Methods: A retrospective cross-sectional study was conducted among the patients admitted in the hospital from April 2018 to April 2019. Blood culture reports of AMR-positive cases were collected from the Microbiology Department and hospitalization records including clinical and demographic data were retrieved from the Medical Records Department. Results: Overall, 251 blood culture reports positive for AMR infection were obtained during the study period. Of this, 96 cases (38.25%, 96/251) were females and 155 (61.75%, 155/251) were males. AMR infection was mostly prevalent among younger age group (0–1 month) with 85.65% (215/251). Methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumonia were the most frequently identified AMR pathogens in the study population with 31.47% (79/251), 23.90% (60/251), and 17.93% (45/251), respectively. Conclusion: The identified AMR pathogens were mostly prevalent among young infants and characterized with multidrug resistance. However, the extended study in increased population mostly among hospitalized cases may provide insights for understanding the burden of AMR and associated risk factors.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Chronic obstructive pulmonary disease (COPD) assessment has emerged as one of the most important parts of COPD treatment. Therefore, a thorough assessment of symptoms is necessary rather than just a measure of dyspnea. Objective: The aim of this study is to assess the disease severity and health status in stable patients of COPD using COPD assessment test (CAT), clinical COPD questionnaire (CCQ) scores, and BODE index and to correlate these indices. Materials and Methods: The study included 100 stable patients suffering from COPD attending outpatient department subjected to CAT, CCQ, and BODE index. Results: CAT and CCQ score correlated significantly (r = 0.52, P < 0.001) and both with the BODE index (r = 0.68; CAT and r = 0.64; CCQ, P < 0.001). COPD severity status and BODE component and forced expiratory volume 1% (FEV1%)-predicted values correlated significantly with individual scores (r = −0.24, CAT; r = −0.41, CCQ; r = −0.72, BODE). Conclusion: An evident negative correlation of FEV1% predicted by CAT and CCQ among study subjects proved both questionnaires as sensitive, simple, and reliable tools not only for early recognition and assessing health status in COPD patients but also for planning appropriate treatment. The BODE index is more objective to assess the disease severity in COPD.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Autoimmune encephalitis causes subacute deficits of memory and cognition, often followed by suppressed level of consciousness or coma. It is a difficult clinical situation due to the similarities in the clinical, imaging, and laboratory findings with many forms of other encephalitides. Materials and Methods: The aim of this article is to study the clinical profile of autoimmune encephalitis. This is a prospective observational study and conducted from August 2014 to July 2017 at Gauhati Medical College, Guwahati. Detailed neurological evaluation along with investigation was done in all the patients. Results and Observation: All patients are diagnosed and categorized as per diagnosis criteria led done by Graus et al. A total of 18 patients were included among which 13 (72%) patients were definite, 3 (16.66%) on probable, and 2 (11%) were possible. Out of the 18 patients, 8 (44%) were males and 10 (56%) were females. The average mean age was 31 ± 4 years and the duration of symptom was 7 weeks ± 4 days. Most common findings were psychiatric symptoms 16 (89%), cognitive decline and short-term memory loss 15 (83%), seizure 14 (78%), movement disorders (hyperkinetic) 13(72%), speech abnormalities 12 (67%), and autonomic dysfunction 4 (22%). Baseline investigations and cerebrospinal fluid analysis revealed pleocytosis along with neural autoantibodies positive in 13 (72%) patients. Electroencephalogram showed epileptiform discharges along with slowing. Magnetic resonance imaging is done in every patient and consistent with the finding of autoimmune encephalitis. Discussion and Conclusion: In the present study, patients presented with varied clinical features with positive neural autoantibodies. A broad approach to testing for infectious diseases and various autoantibodies can lead to the correct diagnosis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Corona virus disease 2019 (COVID-19) caused by severe acute respiratory corona virus 2 (SARS-COV-2) is mainly respiratory disease occurring since December 2019 and first detected in Wuhan province of China. The complexity of SARSCOV-2 is centered on the unpredictable clinical course of the disease that can rapidly develop causing severe and deadly outcomes. The pandemic COVID-19 is a scientific, medical, and social challenge. In this review, the basic pathological and biochemical changes in COVID-19 are described, also how it influences in predicting the disease progression thereby helping in early interventions to prevent complications.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

A 24-year-old female presented with blurring of vision, chemosis, protrusion of eyeball, restriction of movements of right eye, numbness over the right side of the face with severe headache, stiffness of neck, and fever of 2 days duration. She gives a history of recent Covid-19 infection 3 weeks back. She was treated symptomatically and recovered fully. On examination, there was proptosis, chemosis, third, fourth, fifth, and sixth nerve palsy on the right side, and nuchal rigidity. She was started on broad spectrum antibiotics, analgesics, anticoagulant, and prophylactic antifungal thinking in line of post-Covid orbital cellulitis or mucormycosis. Her investigations revealed raised total leucocyte count and erythrocyte sedimentation rate with normal ultrasound abdomen and chest X-ray. Blood culture and culture of nasal swab and oral cavity for fungus were sterile. Contrast-enhanced magnetic resonance imaging brain, orbit, and sinus showed proptosis, myofascial edema, superior ophthalmic vein thrombosis, right cavernous sinus and deep cervical vein thrombosis, sphenoid and bilateral ethmoid sinusitis with narrow lumen of the internal jugular vein. She responded very well to the treatment. Her inflammatory parameters came down drastically and clinically, she started opening her eyes and ophthalmoplegia subsided within a week. By the 10th day she was asymptomatic. Repeat MRI showed reduction of proptosis, myofascial edema with partial recanalization of right superior ophthalmic vein, right cavernous sinus, and right deep cervical vein. She was discharged on injectable anticoagulant and antibiotics for another 10 days.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Primary Sjogren’s syndrome (pSS) is a chronic systemic autoimmune rheumatic disorder that is characterized by lymphoplasmacytic infiltration of the salivary and lacrimal glands. pSS is the most frequent connective tissue disorder after rheumatoid arthritis, affecting 0.3%–3% of the population. The prevalence of pSS is more common in women than men, with a sex ratio of 9:1. Occult pSS can rarely present as immune-mediated cytopenia. In this case report, we exemplify an atypical presentation of pSS that presented as thrombocytopenia. Hence, we should always consider pSS in the differential diagnosis of patients with unexplained cytopenias.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

The delivery of medical education is a complex process, wherein we aim toward not only the acquisition of desired knowledge and skills, but also creating a system and cadre of healthcare personnel who possess the traits of being professional, leader, team-worker, and a lifelong learner. Self-directed learning (SDL) has been regarded as an important aspect of lifelong learning and is one of the core competencies expected of a medical graduate. Most of the regulatory bodies across the globe strongly advocate for the inclusion of SDL activities within the medical school curriculum. The overall process of implementation and faculty training can be supervised by the Medical Education Unit of the institution, along with the members of the Curriculum Committee and phase-wise faculty members. In conclusion, SDL is an essential attribute to ensure lifelong learning among medical students. Considering the wide range of benefits associated with SDL, it is crucial that all the steps are planned and implemented in a systematic manner to enable successful implementation.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Upper gastrointestinal bleeding (UGIB) is a common life-threatening emergency with an overall mortality rate of around 10%. Complete Rockall score is designed to identify patients who are at greater risk of adverse outcome. The aim of this study was to assess the Rockall score as a predictor of adverse outcome in elderly population presenting with non-variceal UGIB. Materials and Methods: This study was an observational study conducted in 116 patients of age >60 years. After stabilizing the patient, endoscopy was performed using a Pentax endoscope. Severity of bleeding was assessed with complete Rockall scoring. The statistical significance was fixed at 5% level (P-value <0.05). Results: The mean age of the study population was 70.16 ± 6.01 years with male-to-female ratio of 2.63:1. Majority of patients (55.17%) presented with both hematemesis and melena. The most common lesion was duodenal ulcer (33.62%). The mean blood transfusion was 1.56 ± 1.14 U. The mean Rockall score was 4.37 ± 2.12. The mean hospitalization was 3.26 ± 1.69 days. Rebleeding occurred in 12.93% of the patients and 8.62% of the patients expired during hospitalization. Out of the 10 patients expired, 20.0% belonged to the moderate-risk and 80.0% belonged to the high-risk Rockall groups, which were found to be statistically significant (P-value <0.001). Conclusion: Acute UGIB is a medical emergency and Rockall score is ideal to stratify elderly patients to anticipate outcome and prognosis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Ovarian hyperstimulation syndrome is an iatrogenic, serious complication of controlled ovarian hyperstimulation, usually self-limited, but occasionally life threatening and typically occurs with gonadotropin. A 32-year-old married female [Para 0+1, 30 weeks (intra-uterine death)—2016], who underwent ovum pick up procedure for secondary infertility, presented to the Department of Nephrology, Apollo Hospital, Guwahati with the complaints of pain in the abdomen, anuria, breathing difficulty, bleeding per vagina on the next day. On investigating the case, the patient had thrombocytopenia, leucocytosis, anemia, normal morphology in peripheral blood smear, raised inflammatory markers, hepatic transaminases, lactate dehydrogenase, and rapidly progressive renal failure, metabolic acidosis with negative serological markers for connective tissue disease. Radio imaging suggested bilaterally enlarged ovaries with multiple hemorrhagic cysts, pleural effusion, and ascites. Ultrasound showed normal sized kidneys with increased echotexture and hypoechoeic cortical rim. Renal biopsy showed diffuse renal cortical necrosis. Supportive management started with a target to correct volume depletion, monitoring, and electrolyte abnormalities. Patient was hemodynamically stabilised and discharged on thrice weekly maintenance dialysis.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Chronic respiratory diseases constitute a grave problem throughout the world and particularly in the middle- and low-income countries. The burden of these diseases leads to poor quality of life and disability of affected individuals leading to premature deaths and a great economic loss to their families and society. Tuberculosis remains one of the deadliest communicable diseases. Though culture is the gold standard for the diagnosis of tuberculosis, the long period of time required for a positive result leads to the transmission of the disease in the community. Objective: The study was conducted to study the prevalence of Mycobacterium tuberculosis in patients suffering from chronic respiratory diseases. Materials and Methods: Bronchoalveolar lavage fluid samples of patients with chronic respiratory diseases undergoing bronchoscopy were collected under aseptic conditions after obtaining approval from the Institutional Ethics Committee. Each sample was subjected to Ziehl Neelsen stain and Cartridge Based Nucleic Acid Amplification Test (CBNAAT) on Xpert MTB/RIF manufactured by Cepheid (Sunnyvale, CA). Results: Eighteen of 110 cases (16.36%) showed the presence of M. tuberculosis in the samples, of which rifampicin resistance was detected in 2 (11.11%) cases. Conclusions: M. tuberculosis remains a common underlying pathogen in the cases of chronic respiratory diseases.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Background: Acute diarrheal infection is a leading cause of outpatient visits, hospitalizations, and lost quality of life. It is defined as the passage of three or more loose or liquid stools per day. The Centers for Disease Control and Prevention (CDC) has estimated 47.8 million cases occurring annually in the United States. According to NFHS-5, the prevalence of diarrhea among under-five children in Assam is 5.5%. Aims and Objective: The aim of this work was to study the clinical and bacteriological spectrum in the recent outbreak of acute gastroenteritis in Silchar Medical College and Hospital. Materials and Methods: A cross-sectional study was conducted on patients with diarrhea admitted in the Medicine Department of Silchar Medical College and Hospital for the time period of January 2016 to March 2016. Result: In our study, a total of 327 patients were enrolled. The median age of patients was 36 years with the majority being female and belong to Hindu religion. All were presented with loose stool, followed by vomiting (85%). The most common pathogen isolated from stool was Escherichia coli (71.2%) followed by Klebsiella (16.2%). More than 50% of cases with E. coli infection are resistant to Piperacillin, Doxycycline, while in cases with Klebsiella infection, more than 50% are resistant to Doxycycline followed by Azithromycin. Conclusion: This study may provide valuable information about the clinical features and microbiology of patients with diarrheal diseases to the Medical practitioners which might help in diagnosis and management.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]

Leptospirosis is a zoonotic disease that predominantly occurs in tropical and subtropical areas. It is caused by the spirochete Leptospira interrogans complex and may lead to syndromes that can vary from a subclinical infection or a mild febrile infection to a severe icterohemorrhagic condition. This is a case report on a 52-year-old farmer who had presented with upper gastrointestinal (GI) bleed. He was initially thought to be a case of complications of Chronic Liver Disease. However, he was later found to have icterus, renal failure, and hemorrhagic manifestations and his IgM ELISA for leptospira was positive. It was later confirmed by MAT. He was treated with antibacterials and supportive measures and his clinical and biochemical parameters improved. The occurrence of Weil’s disease in the month of November and its occurrence in the state of Assam, India was unpredictable and hence posed as a diagnostic dilemma. It is a curable disease and hence needs timely intervention and treatment. This highlights the need for a better understanding of the natural course of this disease and improvement of public health measures.

[ABSTRACT]  [FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Objectives: The aim of this article is to estimate the prevalence of pulmonary hypertension (PHTN) among patients with sickle cell disease (SCD) and to determine the associated factors. Materials and Methods: It was a hospital-based cross-sectional study involving 113 SCD participants in their steady state. Transthoracic echocardiography was done in accordance with the American Society of Echocardiography (ASE) guidelines to determine the peak tricuspid regurgitant velocity (TRVmax); complete blood count, oxygen saturation, serum creatinine, and urea were also done for all the participants. Results: The participants had a mean age of 18.1 ± 9.85 years, and 64 (56.6%) of them were males. Seven (6.2%) of the participants had PHTN as determined by a TRVmax of ≥2.5 m/s. PHTN was significantly associated with age, sex, body mass index (BMI), blood pressure, oxygen saturation, and serum creatinine. Conclusion: PHTN remains common among patients with SCD and it is associated with female gender, increasing age, a rising BMI, blood pressure and serum creatinine, and a decreasing oxygen saturation and hematocrit. We recommend regular screening of patients with SCD for PHTN and that these associated factors should be taken into consideration when screening SCD patients for PHTN.

[ABSTRACT]  [FULL TEXT]  [PDF]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

[FULL TEXT]  [PDF]  [Mobile Full text]  [EPub]

Fever is one of the most common presentations of Systemic Lupus Erythematosus (SLE) (95%) but it is also associated with other manifestations. A 32-year-old female patient who presented with chief complaints of fever and burning micturition and during the course of the stay developed different manifestations like facial rash, leukopenia, proteinuria, and SLE was diagnosed on the antinuclear antibody (ANA) profiling of the patient and the clinical criteria. Here we present a case where the patient presented mainly with urinary tract infection which in turn acted as a trigger for immune reaction leading to the full-blown SLE.

[ABSTRACT]  [FULL TEXT]  [PDF]

Background: COVID-19 pandemic poses a challenge to mental health. The perception of stress and its adaptation are determined by individual’s risk perception and coping mechanisms. Aim: The study aimed to evaluate the perceived stress and behavioral responses owing to COVID-19 pandemic. Materials and Methods: The online survey recruited 621 respondents. The survey included (1) sociodemographic variables, (2) Perceived Stress Scale (PSS)-10 item inventory, (3) four items on experience of stress, and (4) eight items on mental health-related lifestyle changes and societal support during the pandemic. Results: Out of 621, majority were females (54.1%) and belonged to the age group of 18–30 years (66.02%). Moderate perceived stress was observed in 67.1% of the respondents. The mean PSS scores were significantly higher among females, age group of 18–30 years, unmarried, educational qualification below undergraduation, and students. Higher perception of work and financial stress were present in 52.67% and 48.3%, respectively. Increased concern about family and vulnerability was confirmed by 89.05% and 54.59%, respectively. Increased work stress was negatively associated with attention toward mental health, emotional support, physical activity, and hobbies. Greater concern for family and vulnerability had showed positive association with attention toward mental health, emotional support, and protective behavior. Conclusion: In COVID-19 pandemic, females, younger age, and students had significantly higher stress perception. Work and financial stress were associated with maladaptive responses, whereas concern about family and feeling vulnerable were accompanied by positive adaptive responses. Thus, evaluating the cognitive and behavioral responses to stressors is imperative to quantify individual’s stress perception during exposure to a stressful situation such as pandemic.

[ABSTRACT]  [FULL TEXT]  [PDF]