Abstract The use of Morphine in terminal COVID is different from that in palliative care due to variable nature of the pandemic. In developing countries, the limitations in resources that can arise ...during a COVID wave, necessitates the availability of national guidelines for terminal care.
Abstract
We describe a young patient diagnosed with postpartum psychosis, and managed with antipsychotics. She presented with hyponatremia after an episode of gastroenteritis. Further probing ...revealed a history of amenorrhea after the delivery. Workup showed panhypopituitarism. This treatable cause can mimic postpartum psychosis.
A
BSTRACT
Background:
Studies have not proven whether an association exists between diabetic retinopathy (DR) and non-alcoholic fatty liver disease (NAFLD). The reports from various parts of the ...world have not used uniform criteria, and hence, results are inconclusive. Both DR and NAFLD are common conditions encountered in primary care.
Methods:
A total of 130 patients with type 2 diabetes from the medical wards of a tertiary care hospital were enrolled. After documentation of clinical and biochemical data, they underwent ultrasonography (USG) of the abdomen and fibroscan grading of liver. Retinopathy was assessed and classified as per the Early Treatment Diabetic Retinopathy Study.
Results:
The mean age of the patients included in the study was 46.5+/-8.8 with 55% of the participants being male and 45% female. The mean HbA1c was 7.168+/2.4. The association between DR and hepatic fibrosis was assessed by fibroscan (p 0.003) and USG (p 0.001) and was significant on univariate analysis. Multivariate analysis did not confirm this. There was no association between increasing grades of either condition. Although fibroscan and USG significantly concorded in diagnosing NAFLD, fibroscan diagnosed more cases as compared to USG (83 vs 73).
Conclusion:
Larger studies should be conducted to conclusively determine the association in order to investigate pathogenetic factors and treatment strategies.
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5.
Diabetes Day 2017 Idiculla, Jyothi
Indian journal of endocrinology and metabolism,
01/2018, Volume:
22, Issue:
1
Journal Article
Peer reviewed
Open access
Effect of intensive diabetes management on macrovascular events and risk factors in the Diabetes Control and Complications Trial. Mazzuca SA. Does patient education in chronic disease have ...therapeutic value? J Chronic Dis 1982;35:521-9. Department of Internal Medicine and Clinical Ethics, St. John's Medical College, Bengaluru, Karnataka
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Background: Diabetes Mellitus (DM) and hyperglycaemia (HG) have been identified as risk factors for morbidity and mortality in coronavirus disease 19 (COVID-19) infection. However, a detailed study ...of various categories of HG and the impacts and characteristics of each of these on COVID-19 was considered important to address this metabolic disorder in COVID-19. Aims: This study aimed to describe the patterns of HG and its impact on the clinical outcomes in hospitalised patients with COVID-19 infection. Methodology: Data on 1000 consecutive patients with COVID-19 were analysed using Statistical Package for Social Sciences (SPSS) version 20.0 software (SPSS Inc., Chicago, IL, USA). Results: A total of 1000 patients were included for analysis The overall mean age of the study group was 52.77 + 19.71 with 636 (63.6%) male patients; 261 had mild, 317 moderate, and 422 severe infections; and 601 had HG (New-onset DM 66, known DM 386, steroid-induced HG 133 and stress HG 16). The HG group has significantly higher levels of inflammatory markers and worse outcomes. Blood glucose levels were higher in patients with known DM. The ROC cut-off of total steroids to predict mortality in the HG group was 84 mg versus 60 mg in the normoglycaemia group. The ROC cut-off of FBS to predict mortality in the overall HG group was 165, with AUC 0.58 (95% CI 0.52, 0.63, P = 0.005), whereas that for pre-existing DM and steroid HG were 232 and 166, which were also significant. There was a wide variation in mean glucose levels against time. Conclusion: HG is an independent predictor of mortality, with the highest significance in the steroid-induced category. COVID-19 morbidity and mortality can be minimised by identifying the blood glucose range for best results and instituting appropriate treatment guidelines.
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Thyroid dysfunction in patients with human retroviral infection has been reported but the prevalence of thyroid function abnormalities in patients on highly active antiretroviral therapy (HAART) has ...not been studied. We aimed to assess the prevalence of thyroid dysfunction and autoimmunity (antithyroid peroxidase auto-antibodies TPO-Ab) in patients on first-line HAART, identify risk factors for thyroid dysfunction and determine any association of thyroid dysfunction with HAART.
We screened and enrolled consecutive patients from the outpatient department if they were (i) diagnosed with HIV infection (enzyme-linked immunosorbent assay); (ii) aged more than 18 years; (iii) on HAART for 1 year or more; and (iv) clinically stable with no evidence of any acute illness in the past 2 months. We excluded patients who were on drugs that affect thyroid function. Thyroid function tests and CD4 counts were done.
A total of 159 patients on firstline HAART were included in the study. Their mean (SD) age was 43.3 (10) years and duration of HAART was 44.4 (33.54) months. The mean CD4 count was 502.8 (274.45). Forty-seven patients (29.6%) had thyroid dysfunction. TPO-Ab positivity was noted in 6 patients. No association was seen between thyroid dysfunction and any type of regimen or drug. There was a significant negative correlation between CD4 counts and thyroid-stimulating harmone (TSH) suggesting that thyroid dysfunction may be more prevalent when immunity is low.
There is a high prevalence of thyroid dysfunction, predominantly subclinical hypothyroidism, in patients on HAART. Thyroid autoimmunity is low in this subset of patients. Lower immunity is associated with higher TSH levels. Larger longitudinal studies are required to determine the course of hypothyroidism in patients on HAART.
Abstract
Background:
Advancing age and multimorbidity are well-established risk factors for the incidence and severity of coronavirus disease 2019 (COVID-19) infection.
Aims:
To describe the clinical ...profile of hospitalized elderly patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to assess the risk factors for mortality.
Methodology:
Data on 465 consecutive patients aged 60 years and above admitted with COVID-19 at St John’s Medical College Hospital, Bangalore, were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0 software (SPSS Inc., Chicago, IL, USA).
Results:
A total of 465 patients were included for the analysis. The overall mean age of the study group was 67 ± 4 years with 315 (67.9%) male patients. Eighty-one patients had mild, 117 had moderate, and 267 had severe COVID-19. After adjusting for age, gender, glycemic status, and COVID severity in the multivariate logistic regression analysis, elevated neutrophil-to-lymphocyte ratio (adjusted odds ratio aOR 1.93 95% confidence interval CI 1.14–3.29), end stage renal disease (aOR 3.49, 95% CI 1.34–9.06), acute kidney injury (aOR 3.25, 95% CI 1.94–5.41), shock (aOR 13.53 95% CI 6.35–28.82), mechanical ventilation (aOR 8.53, 95% CI 4.85–15.00), and intensive care unit care (aOR 14.5 95% CI 7.42–28.38) were the independent predictors of mortality.
Conclusion:
COVID-19 is characterized by poor outcomes and mortality, especially among older patients who have multiple comorbid illness.
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Abstract
Hypercalcemia can manifest with various symptoms and poses diagnostic challenges due to its multifactorial etiology. This case highlights a 74-year-old patient with hypercalcemia of complex ...origin. The patient had a history of chronic liver disease, chronic kidney disease, and a previous episode of hypercalcemia associated with excessive oral Vitamin D intake. On admission, the patient presented with disorientation and increased drowsiness. Further evaluation revealed persistently high serum calcium levels, low parathyroid hormone levels, and elevated levels of Vitamin D. Investigations identified a duodenal nodule with multiple lymph node enlargement, suggesting a malignancy as the underlying cause. Other potential factors contributing to hypercalcemia, such as a granulomatous disease, prolonged immobilization, and a deactivating mutation of the 24-hydroxylase gene (CYP24A1), were also considered. Despite interventions, including hemodialysis and denosumab administration, the patient’s condition deteriorated due to sepsis and hypotensive shock, ultimately resulting in death. This case emphasizes the importance of considering multiple etiologies in cases of hypercalcemia in the elderly and the challenges involved in managing severe symptomatic hypercalcemia. Medical professionals must employ sound clinical reasoning and comprehensive diagnostic approaches to accurately identify and address the underlying cause. Hemodialysis may be necessary in refractory cases to achieve serum calcium normalization.
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