Explore the vast range of titles available.

COVID-19 pandemic had adversely affected the services of the tiol Tuberculosis (TB) Elimition Programme, resulting in psychological distress among pulmory tuberculosis patients (PTB). This cross-sectiol, hospital-based study included 361 PTB patients. Three pre-defined questionires were used for the alysis, a questionire to evaluate anxiety related to COVID-19, a patient health questionire (PHQ-9) for depression, and a fear of COVID-19 scale (FCV-19S) questionire. Among 361 PTB patients, 13% (n=47) had COVID-19 infection. Out of the total patients, 69% (n=250) were DR-TB (drug resistance-tuberculosis) cases. Proportion of anxiety, fear and depression due to COVID-19 was found in 49% (n=177), 23% (n=83), 67% (n=247) respectively. Delay in the initiation of anti-tubercular treatment was found in 58% (n=210) of the cases, among which the majority, i.e., 69% (n=172, p=0.011), were DR-TB. This pandemic has led to a sudden step-down of PTB. Trend alysis of the psychological distress showed a peak following the COVID-19 pandemic. Most DR-TB patients had delayed initiation of the anti-tubercular treatment during the pandemic. The preponderance of the younger age group was seen in the pulmory tuberculosis patients, and a majority of them had DR-TB. Depression was the predomint psychological distress among the study subjects during the pandemic.

Background: Utilizing the two available prediction models, i.e., the dual antiplatelet therapy (DAPT) score and predicting bleeding complication in patients undergoing stent implantation and subsequent dual antiplatelet therapy (PRECISE-DAPT) score, we aimed to determine the appropriateness of the DAPT in patients with acute myocardial infarction (AMI) in patients undergoing percutaneous coronary intervention (PCI).Methods: We retrospectively enrolled 235 patients of AMI and for all the patients and thorough information regarding history, risk factors, and medications were collected. Both DAPT and PRECISE-DAPT scores were calculated. The patients were divided by their recommended cutoffs and the appropriateness of the duration of the recommended DAPT was measured based on the observed scores. Bleeding academic research consortium (BARC) classification was used to define the bleeding events. In the patients with DAPT score ≥ 2 and PRESICE-DAPT < 25, the prolonged use of DAPT was recommended.Results: Overall, 235 patients, predominantly male (78.7%), with baseline characteristics exhibiting high rate of smoking (31.1%), diabetes (35.3%), and hypertension (32.8%) were found. The widely prescribed DAPT combination was aspirin with clopidogrel (72.3% at discharge and 46% on current use). Among all the enrolled patients, 163 patients were on DAPT while 71 were on single antiplatelet therapy (SAPT). A significant association between DAPT and PRECISE-DAPT scores was noted in terms of SAPT and DAPT. The appropriateness of DAPT was checked based on the scores, where 81% of the patients with DAPT ≥ 2 and 77.24% with PRECISE-DAPT score < 25 were appropriately prescribed with DAPT. The primary reason for drug interruptions was self-advised. The incidence of bleeding events was observed to be 7.23%, among which 5.1% had Type 1 bleeding according to BARC.Conclusion: Both DAPT and PRECISE-DAPT scores could be used to determine the appropriateness of the recommendations of DAPT in patients with AMI or undergoing PCI.

Here, authors present a review on clinical presentation and management of exposure of phosgene gas after reviewing the literature by searching with keywords phosgene exposure on Google, Cochrane, Embase and PubMed with a background of experience gained from 10 patients who were admitted to our institute after an accidental phosgene exposure in February 2011 nearby a city in India. Phosgene is a highly toxic gas, occupational workers may have accidental exposure. The gas can also be generated inadvertently during fire involving plastics and other chemicals and solvents containing chlorine, which is of concern to emergency responders. Phosgene inhalation may cause initially symptoms of respiratory tract irritation, patients feel fine thereafter, and then die of choking a day later because of build up of fluid in the lungs (delayed onset non-cardiogenic pulmonary edema). Phosgene exposure is associated with significant morbidity and mortality. Patients with a history of exposure should be admitted to the hospital for a minimum of 24 h for observation because of the potential for delayed onset respiratory failure and acute respiratory distress syndrome.

Introduction: Psychiatric disorders, especially anxiety and depression have been reported to have an increased prevalence in chronic obstructive pulmonary disease (COPD) patients, but there is a paucity of data from India. Aims and Objectives: Aim of our study is to study the frequency of psychiatric comorbidities in COPD patients and their correlation with severity of COPD, as per global initiative for obstructive lung disease guidelines. Materials and Methods: This study was conducted in outpatient department of a tertiary care hospital (King George's Medical University). A total of 74 COPD patients were included in this study and compared with 74 controls. The diagnosis and severity of COPD were assessed by spirometry. Psychiatric comorbidities were assessed using the Mini International Neuropsychiatric Interview questionnaire. Results: The frequency of psychiatric comorbidities was significantly higher (P < 0.05) in COPD patients (28.4%) as compared to controls (2.7%). As regards to severity, the frequency was significantly increased in severe and very severe COPD. The frequency of psychiatric comorbidities in COPD patients increased significantly with the increase in duration of symptoms being present in 67% of patients with duration of symptoms more than 10 years and only 23% of patients with duration of symptoms ≤5 years. Conclusion: The frequency of psychiatric comorbidities is increased in COPD patients as compared to controls. We recommend that all patients with COPD should be screened for psychiatric comorbidity, if any.

The rare endocrine condition known as Van Wyk-Grumbach syndrome (VWGS) is typified by delayed bone age, multicystic ovaries, isosexual precocious puberty and increased, untreated primary hypothyroidism. It typically presents in paediatric patients but can occasionally be missed until adulthood. We report an unusual adult presentation of VWGS in a short-statured woman in her early 20s who presented with menorrhagia-induced severe anaemia, hypothyroid features and multicystic ovaries. Laboratory evaluation revealed markedly elevated thyroid-stimulating hormones, hyperprolactinaemia, elevated oestradiol and low luteinising hormones. Imaging showed a hypoplastic thyroid and enlarged multicystic ovaries. The initiation of levothyroxine therapy resulted in normalisation of thyroid function and the eventual resolution of ovarian cysts. She later conceived successfully. This case highlights how crucial it is to identify VWGS early to avoid difficulties and enhance results. Timely thyroid hormone replacement can reverse hormonal disturbances, restore fertility and prevent unnecessary surgical interventions. This case report describes a unique presentation of VWGS in a short-statured woman in her early 20s with severe anaemia due to menorrhagia, associated with severe hypothyroidism.

Context: Glycated hemoglobin A 1 c (HbA 1 c) indicates long-term uncontrolled hyperglycemia in the body, which in diabetic patients leads to various vascular complications as a part of generalized atherosclerosis culminating ultimately into ischemic stroke. Aims: Study aims to show the association between marker of uncontrolled long-term hyperglycemia HbA 1 c and marker of atherosclerosis (Carotid intima media thickness [CIMT] and carotid plaque) in ischemic stroke patients. Subjects and Methods: Carotid sonography using high resolution 7.5 MHz sonography technique was done in each patient to find the occurrence of increased CIMT and presence of plaque according to Mannheim CIMT Consensus (2004-2006). Levels of HbA 1 c measured in blood in both diabetic and non-diabetic patients and a comparison made between them. Finally an association sought between HbA 1 c levels with CIMT and plaque. Results: The average value of HbA 1 c of this cohort was 7.51 ± 1.75% with higher values in diabetic patients (9.29 ± 1.73%). The patients with high CIMT (>0.8 mm) had higher values of HbA 1 c then that of normal CIMT patients and this was nearly significantly (P = 0.06). However, HbA 1 c levels of blood were significantly associated with stroke patients with presence of carotid arteries plaque (P = 0.008). Conclusions: Prediction of future risk and prevention strategies for ischemic stroke could be formulated by utilizing HbA 1 c levels in both diabetic and non-diabetic population.

Rabies is an almost always fatal disease that physicians and patients dread due to its dismal prognosis and limited treatment options. Transmission of this disease occurs through the bite of dogs and wild animals (like jackal in our case). Other rare forms of transmission may be through inhalation in bat-infested caves and human-to-human transmission by infected corneal transplants, solid organ and tissue transplantation, and sometimes in laboratory settings. Its diagnosis is usually clinical in the absence of availability of special laboratory investigations at the point-of-care facility. Few people have described the role of imaging in diagnosis. We hereby report a patient with rabies encephalitis, having a history of jackal bite and classical MRI findings that we can use for early diagnosis in the absence of typical clinical features and specialised diagnostic testing.

Background & objectives: In clinical settings, peripheral blood pressure (PBP) is measured routinely. It is thought that central blood pressure (CBP) which reflects aortic BP, may be more predictive of outcomes in specific populations. Hence, this study was carried out to measure CBP in patients with hypertension and to see the effect of antihypertensive drugs on CBP. Methods: This cross-sectional study was conducted on 134 hypertensive patients and 134 normotensive healthy individuals as controls. Peripheral BPs and CBPs were measured of all patients and controls. The data were correlated and the effect of antihypertensive drugs on CBP was also evaluated. Results: Of the 134 hypertensive patients, 44 (32.84%) were newly diagnosed and the rest 90 (67.16%) had a history of hypertension and were on treatment. Of these 90 patients on treatment, 37 (41.11%) had uncontrolled peripheral BP and 53 (58.89%) had normal peripheral BP. Of the 134 hypertensive patients, 45 (33.58%) had controlled CBP. In 90 patients, who were on antihypertensive treatment, 45 (50%) had controlled CBP and 45 (50%) had uncontrolled CBP. Patients on calcium channel blockers (CCBs) had better control of CBP. Interpretation & conclusions: Hypertension is diagnosed mainly by measuring peripheral BP. CBP, which correlates better with the incidence of cardiovascular events, is not routinely measured. Patients with a history of hypertension and on treatment had normal office peripheral BP, but a few of them had high CBP and may require modification in treatment for control of CBP. Control of CBP was better in patients taking CCB.

Introduction: Obstructive sleep apnea (OSA) and hypothyroidism are closely linked as hypothyroidism has been shown to lead to the development of OSA through multiple mechanisms. With the changing lifestyle patterns worldwide and increased prevalence of obesity, the burden of OSA has substantially increased. The association of OSA with hypothyroidism is essential to establish. If identified early, treatment of OSA and associated hypothyroidism can be done timely to minimize the potential harmful complications of OSA on all aspects of the patient's health. Aims: This study was done to find out the prevalence of OSA in hypothyroidism patients. Setting and Designs: It was a cross-sectional study, done over a period of 1 year in a tertiary care hospital. Materials and Methods: A total of 100 hypothyroidism patients were enrolled after taking written consent. All patients were subjected to STOP-Bang questionnaire and patient falling in intermediate-high risk (score3-8), were taken for overnight polysomnography to confirm the diagnosis of OSA (AHI ≥5). Statistical Analysis Used: The Statistical Package for the Social Sciences version 21.0 statistical analysis software. Results: Out of 100 patients, who underwent polysomnography, 74 (74%) cases had OSA (AHI ≥5). Out of total 74 OSA cases, 29 (39.2%) cases had mild OSA (AHI 5-14), 15 (20.3%) cases had moderate OSA (AHI 15-30), and 30 (40.5%) cases had severe OSA. The age of the study population ranged between 24 and 78 years and the mean age was 58.28 ± 11.22 years. The mean age of the patients in the OSA group (59.27 ± 11.17 years) was higher than the non-OSA group (55.46 ± 11.09 years). Majority (64%) of our cases were male, and the proportion of males was found to be higher than females in both the groups (OSA/non-OSA). The body mass index (BMI) of the OSA group was found to be statistically higher as compared to that of the non-OSA group (P = 0.040). The BMI was found to be higher in severe OSA, but it was not statistically significant (P = 0.128). The mean value of FT4 was lower and thyroid-stimulating hormone (TSH) was higher in the OSA group as compared with the non-OSA group. However, no significant association was found between FT4 and TSH values in both the groups. Out of 100 cases, 41 patients were treatment naïve with mean TSH value of 13.1 ± 7 and 59 were on treatment with mean TSH of 8.3 ± 4. Treatment-naïve patients had a statistically higher number (85.3%) of OSA cases in comparison to patients on treatment (66.1) (P = 0.030). Conclusions: Prevalence of OSA is quite high in hypothyroidism. Patients with hypothyroidism should be screened for OSA for early diagnosis, especially in individuals with higher BMI. Treatment of hypothyroidism reduces the prevalence of OSA.

Chronic obstructive pulmonary disease (COPD), a heterogeneous lung disorder that is characterized by airflow obstruction and the third leading cause of death, globally. COPD is influenced by environmental and genetic factors. Here, we measured the serum level of matrix metalloproteinase-9 (MMP-9), cyclooxygenase-2 (COX-2) and prostaglandin E-2 (PGE-2) and reveal the correlation between their levels in COPD subjects. In this study, we included a total of 79 COPD and 79 healthy controls. We assessed demographic profile, risk factors, respiratory symptoms, clinical history, COPD Assessment Test (CAT) score and spirometry. Further, we determined the serum levels of MMP-9, COX-2 and PGE-2 by enzyme-linked immunosorbent assay (ELISA). The correlation between their serum levels was also determined. Among the studied population age, gender, body mass index and socioeconomic status were comparable. Serum levels of MMP-9, COX-2 and PGE-2 were significantly increased in the COPD group than in healthy controls (P < 0.0001). Moreover, MMP-9, COX-2 and PGE-2 levels were increased with the GOLD grades and CAT score (> 10). Serum levels of MMP-9, COX-2 and PGE-2 was enhanced in patients with larger clinical history (> 20 years) than those with lower clinical history (< 10 years). Serum levels of MMP-9 and COX-2; MMP-9 and PGE-2; COX-2 and PGE-2 showed a positive correlation (P < 0.0001) with the COPD group. Our data demonstrate that serum levels of MMP-9, COX-2 and PGE-2 were correlated with the GOLD grade, CAT score and clinical history of the COPD group, pointing that they can be used as a indicators to understand the disease progression.