Indian Journal of Medical Specialities最新文献

{"title":"SARS CoV-2-related multisystem inflammatory syndrome in adults: An observational case series from tropics","authors":"Sameer Gulati, Aniket Jagtap, Y. Porwal, Paras Kathuria, Ankur Chikara","doi":"10.4103/injms.injms_22_22","DOIUrl":"https://doi.org/10.4103/injms.injms_22_22","url":null,"abstract":"Background: Extrapulmonary multisystemic manifestations in children were recognized, early in the pandemic, Multisystem Inflammatory Syndrome in Children (MIS-C). Of late, similar manifestations have been reported in adults (Multisystem Inflammatory Syndrome in adults - MIS-A) in too. As new variants of SARS-CoV 2 emerge and fade away, MIS-A needs to be recognized at the most opportune time. Besides, we hypothesize that MIS-A may also co-exist with other tropical infections to further confuse diagnostic scenario. Methodology: A series of five cases of MIS-A is presented. Their demographic, comorbidities, and clinical data were noted. Besides, the clinical and laboratory parameters of patients with and without tropical infections were compared. Results: Patients presented with diverse heterogenous clinical manifestations. The cardiovascular, hematological, and abdominal systems were most commonly involved along with high inflammatory markers. Three of our patients in the present series had tropical infections along with MIS-A. There was no statistically significant difference between clinical manifestations and laboratory parameters among MIS-A patients with and without tropical infections. All the five patients improved on treatment and were discharged home. Conclusions: A high index of suspicion is required to diagnose MIS-A, especially in tropical areas where background rate of other infections is also high. Moreover, these tropical infections may co-occur along with MIS-A, further confusing the diverse heterogenous clinical presentations. Patients with MIS-A may be critically ill, but outcomes are good if lifesaving immunosuppressive therapy is initiated on time.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":"13 1","pages":"143 - 149"},"PeriodicalIF":0.6,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49587677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unraveling scrub encephalitis: A study on the clinical profile and investigations of scrub encephalitis","authors":"C. Sukumar, N. Bolanthakodi, Laawa Lakhmani, Ajit Singh, S. Vidyasagar","doi":"10.4103/injms.injms_110_21","DOIUrl":"https://doi.org/10.4103/injms.injms_110_21","url":null,"abstract":"Introduction: Scrub encephalitis (SE) is one of the known causes of acute encephalitis syndrome (AES). Although central nervous system involvement is known in scrub typhus, its association with AES is less understood and lesser diagnosed. In the absence of a point of care test for scrub typhus, cases of SE can be easily missed. A clinical approach using detailed history and clinical profiling of SE will help to diagnose SE in our region, using minimum resources, within a reasonable period. Aims: To analyze the clinical spectrum in patients of SE and to evaluate the investigations required to diagnose SE. Methodology: This is a retrospective study that analyzed Scrub typhus patients over 2 years from January 2018 to December 2019. A total of 370 patients were screened and 23 patients who satisfied the study criteria were included in the study and analyzed. Results: Among the cases of scrub typhus admitted in the hospital, the prevalence of SE was 6%. The most common presenting complaint was fever in 21 patients (91%) followed by altered sensorium in 16 (70%) and seizures in 9 patients (39%). An eschar was noted in 66% of the cases. The mean Glasgow Coma scale was 11 among the cases with almost 70% of cases showing signs of meningeal irritation. Organ involvement was noted as thrombocytopenia in 21 patients (91%), 16 patients (69%) with jaundice, and 1 (4%) with acute kidney injury. Conclusion: SE is an AES which, if detected early, is easily treatable with no residual neurological sequelae. Hence, identification of this condition and prompt diagnosis of SE becomes crucial to the management of this complication of scrub typhus.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":"13 1","pages":"77 - 81"},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49056993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Depression, anxiety, and stress among general public of india during post-COVID-19 second wave: A web-based cross-sectional survey","authors":"J. Mekala, Narayana Goruntla, B. Nayaka, Kavyasree Velpula, Raghavendra Biswas, K. Veerabhadrappa, B. Pradeepkumar","doi":"10.4103/injms.injms_103_21","DOIUrl":"https://doi.org/10.4103/injms.injms_103_21","url":null,"abstract":"Background: Evidence suggests that one-third of respondents had a significant psychological impact in the lockdown period of the coronavirus disease 2019 (COVID-19) pandemic. This indicates a need for longitudinal assessment of the psychological needs of the public to plan holistic interventions. Aim: To investigate depression, anxiety, and stress (DAS) levels among the general public post-COVID-19 second wave. Materials and Methods: A web-based cross-sectional survey was conducted among the general public who were aged above 15 years. The data were collected through online mode by providing a link to fill Google Form. The survey tool was disseminated in various messenger groups and social media networks. The survey tool comprises demographics, COVID-19 stressors, and DAS Scale 21 (DASS-21). Multi and Univariate linear regression analysis was used to correlate patient characteristics and COVID-19 stressors with DASS-21 subscales. Results: A total of 2515 (males = 1274; females = 1241) people participated in this web-based survey. The mean age of the study respondents was 31.3 ± 13.4 years. The mean scores of depression, anxiety, and stress were 6.8 ± 8.6, 5.0 ± 7.3, and 7.3 ± 8.6, respectively. The majority of the participants are normal in all sub-scales of DASS-21. Very few are experiencing symptoms of severe or extremely severe depression (4.2%, 4.3%), anxiety (3.3%, 6.9%), and stress (3.0%, 2.3%). Geriatrics, females, health-care workers, homemakers/unemployed/retired people, rural residents, and people suffering from co-morbidities have a significant elevation of DAS scores with a P < 0.05. Conclusion: Even though most of the respondents are free from the DAS symptoms, few are still (post-COVID-19 second wave) experiencing symptoms of severe or extremely severe DAS subscales. More interview-based and probability sampling future studies are warranted to minimize the biases present in the study.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":"13 1","pages":"87 - 94"},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49642483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mucormycosis in the setting of the Covid-19 pandemic in patients without exposure to steroids and oxygen: A case series from a tertiary care center in North India","authors":"Sachindanand Gautam, M. Daga, G. Mawari, N. Kumar, Ishan Rohatgi, Maryam Hussain, Vaishali Ramteke, S. Garg, Suresh Kumar, Sarika Singh, Ishwar Singh","doi":"10.4103/injms.injms_133_21","DOIUrl":"https://doi.org/10.4103/injms.injms_133_21","url":null,"abstract":"Background: Sudden surge of mucormycosis cases in India needs an urgent attention as multiple factors have been implicated. However, diabetes mellitus remains to be one of the most important and modifiable factors. Methodology: We prospectively followed 11 patients with mucormycosis in May 2021 and June 2021, admitted to our hospital to study the possible etiologies. Results: Out of the 11 patients, six were males and five were females, with an average age of 52.45 years. Type 2 diabetes mellitus was the ubiquitous comorbidity, and every patient presented with uncontrolled hyperglycemia (six out of them were in diabetic ketoacidosis). Glycated hemoglobin levels ranged from 10.2% to 15.1%. Out of 11 patients, four patients were non-COVID, whereas five patients had a history of COVID-19 infection. All these five post COVID-19 patients presented approximately 20 days after recovery, out of which one patient had severe infection who was hospitalized. The remaining two patients were COVID-19-positive. Out of 11 patients, 10 patients had rhino-orbital mucormycosis at presentation, among which four patients had cerebral involvement, and one out of them later developed invasive disease. However, one patient had only pulmonary mucormycosis at presentation. Serum ferritin was raised in all the patients, and six had serum zinc levels below the reference range. Serum flow cytometry showed leukopenia with normal CD4:CD8 ratio in seven patients. In the clinical outcome, six patients expired, whereas five patients responded to the treatment and were discharged on oral posaconazole therapy. Conclusion: From our study, it is quite evident that uncontrolled diabetes and its complications such as diabetic ketoacidosis were an important risk factor for the occurrence of mucormycosis in COVID-19 patients as well as non-COVID-19 patients, even without exposure to steroids or oxygen. Thus, blood glucose levels should be kept at optimum level during the management of COVID-19 patients.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":"13 1","pages":"113 - 118"},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42387647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improvement of the nurses' awareness toward ventilator-associated pneumonia based on evidence guidelines","authors":"Z. Alaswad, M. Bayoumi","doi":"10.4103/injms.injms_124_21","DOIUrl":"https://doi.org/10.4103/injms.injms_124_21","url":null,"abstract":"Background: Ventilator Associated Pneumonia (VAP) is a common hospital acquired infection that occurs as complication in patients who are connected to Mechanical Ventilation (MV). Nurses in intensive care unit (ICU) should be updated with the latest evidence-based practice to prevent such complication. This study aimed to assess improvement of the nurses' awareness toward ventilator-associated pneumonia based on latest evidence guidelines. Methods: A quantitative pretest-posttest design has been conducted. Using a convenience sample of 58 nurses who are working in the ICU were recruited. Tools: A self-administrative questionnaire was adapted to assess the nurse's knowledge about VAP and VAP prevention bundle. Results: The results highlighted that all ICU nurses had improvement of knowledge level pre-post regarding VAP (p <0.001), VAP prevention (p <0.001), and the overall knowledge score improvement revealed significantly higher after the educational program (p <0.001). Conclusion: Periodic refreshing on-services education program should be provided to nurses in ICU to improve their knowledge and to maintain high level of information, moreover hospital policies should include updated guidelines for VAP prevention bundle and protocol from international evidence.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":"13 1","pages":"95 - 100"},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46649830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Is chronic obstructive pulmonary disease different in females as compared to males?","authors":"Rita Bothara, M. Holay","doi":"10.4103/injms.injms_118_21","DOIUrl":"https://doi.org/10.4103/injms.injms_118_21","url":null,"abstract":"Background: Recent years have witnessed a major shift in the sex profile of the chronic obstructive lung disease (COPD). In India, while smoking remains a significant risk factor, COPD due to nonsmoking causes (like biomass exposure) accounts for 30%–50% of all COPD cases. There is a lack of studies on characteristics of women with COPD exposed to biomass smoke and the degree to which they differ from COPD in men from the Indian context. Aim: The aim was to study clinical profile, risk factors, and severity of COPD in females and compare the same with COPD in males. Materials and Methods: 100 cases of COPD were divided into two groups – 50 Females and 50 males and were analyzed further for clinical profile and were graded as per the GOLD criteria and BODE index. Results: The mean age of presentation in females was 62 years. Biomass smoke exposure was the most common risk factor in females and that in males was smoking. Females had more severe dyspnea as compared to males (P = 0.022). There was a significant statistical difference in the performance of 6-min walk test (P = 0.005) and number of exacerbations in the past year in females (mean 4.5) and males (mean 3.58) (P = 0.034). Majority of female patients belonged to GOLD Groups B and D. Mean BODE index was 4.98 in females and 4.24 in males, and the difference was statistically significant (P = 0.014). Conclusion: There are gender-related differences in COPD risk, progression, and outcomes. Females have more symptoms, more severe obstruction, more number of exacerbations, and more functional disability as compared to males.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":"13 1","pages":"82 - 86"},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46132766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Artesunate-induced vasculitis in an empirically treated patient with febrile illness","authors":"R. Sud, Ridhi Chhabra, N. aggarwal, L. Gupta","doi":"10.4103/injms.injms_117_21","DOIUrl":"https://doi.org/10.4103/injms.injms_117_21","url":null,"abstract":"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.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":"13 1","pages":"127 - 129"},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42692528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hand sanitizer: A double-edged sword used in the COVID-19 pandemic","authors":"S. Sidharth, Ramesh Aggarwal, L. Ghotekar, S. Margekar, Omprakash Kumar","doi":"10.4103/injms.injms_127_21","DOIUrl":"https://doi.org/10.4103/injms.injms_127_21","url":null,"abstract":"The COVID-19 pandemic has taught us the emphasis of personal hygiene which was long being ignored. Measures such as hand sanitizer which were predominantly used in health-care facilities in the past have seen recent surge in its usage everywhere. The availability of hand sanitizer in almost all the settings in this pandemic including the household has heralded a new step in personal hygiene. People across the world are using hand sanitizer everywhere. As much is known about its beneficial effect in preventing the spread of pathogens, its injudicious use has resulted in discovering its adverse effect if misused. We hereby present a case where the patient with Type 1 diabetes mellitus presented with hand sanitizer ingestion. This case highlights the unwanted effects and lethality of hand sanitizer if used in an unintended manner and hence alert us for its judicious use in the pandemic.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":"13 1","pages":"130 - 131"},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42564236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A fatal disease hidden behind a common symptom: Neuromyelitis optica spectrum disorder","authors":"V. Sharma, A. Umashankar","doi":"10.4103/injms.injms_99_21","DOIUrl":"https://doi.org/10.4103/injms.injms_99_21","url":null,"abstract":"Neuromyelitis optica spectrum disorder (NMOSD) is an inflammatory demyelinating disorder of the central nervous system. Recently, a number of clinical features have been identified in the diagnosis, and this disorder has been expanded to include a wider spectrum. It is important to have knowledge of these syndromes to diagnose this condition. One such presentation is intractable vomiting and hiccoughs, which is categorized as area postrema syndrome (APS) and is often misdiagnosed as a digestive disorder. We present a case of young female presenting with unresolving vomiting and hiccoughs. Magnetic resonance imaging done showed lesions in the dorsal medulla, suggestive of APS. A positive immunoglobulin G aquaporin-4 antibody confirmed the diagnosis of NMOSD. With this case report, we try to reiterate the importance of knowing the varied presentations of NMOSD and vigilance in identifying that a common symptom such as vomiting/hiccough can be due to an uncommon disorder.","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":"13 1","pages":"124 - 126"},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46428652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"White dots syndrome and pseudoxanthoma elasticum: An unusual association","authors":"Belfaiza Soukaina, T. Abdelaoui, I. Jeddou, Y. Mouzari, K. Reda, Oubaaz Abdelbar","doi":"10.4103/injms.injms_5_22","DOIUrl":"https://doi.org/10.4103/injms.injms_5_22","url":null,"abstract":"","PeriodicalId":43811,"journal":{"name":"Indian Journal of Medical Specialities","volume":"13 1","pages":"134 - 135"},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46547999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}