Observational study on the clinical profile and treatment outcome on long-term follow-up of COVID-19 associated mucormycosis.

MATERIALS AND METHODS: Patients diagnosed with COVID-19 associated mucormycosis were followed up for 6 months to study the clinical profile, readmissions, long-term treatment outcome and the mortality rate. RESULTS: Among 37 patients with COVID-19 associated mucormycosis, the mortality rate was 33.3 %, 42.9% and 100 % among patients with mild, moderate and severe COVID-19 infection. One month after discharge, among the 20 patients who survived, 10 (50 %) patients had worsening symptoms and required readmission. Nine patients required readmission for amphotericin and 1 patient was admitted for surgical intervention. On follow-up at 1 month, 30 % (6/20) patients became asymptomatic. However, at 3 months, 45 % (9/20) of the patients were asymptomatic. At 6 months of follow-up, 80 % (16/20) were asymptomatic. At 6 months, one each had residual abnormalities like visual loss in one eye, visual field deficit, change in voice and residual weakness of the limbs along with cranial nerve paresis. CONCLUSION: The follow-up study revealed that a significant number of patients required readmission within the first month, but most of the patients became asymptomatic by 6 months. The readmission rate was higher in patients who received a shorter duration of amphotericin.

Disseminated Cryptococcosis in a Young Immunocompetent Male.

Cryptococcosis is an opportunistic infection caused by encapsulated yeasts of genus Cryptococcus. It usually infects immunocompromised patients and has multisystemic involvement, the common sites being lungs, central nervous system, skin and bone marrow. Disseminated cryptococcosis has also been reported in immunocompetent individuals. We present an immunocompetent patient with disseminated cryptococcosis and extensive bone marrow involvement.

Etiology, Clinical Profile and Outcome of Encephalopathy in Elderly.

BACKGROUND: Diagnosis and delay in management of encephalopathy in elderly patients is challenging due to the paucity of presenting symptoms and signs. METHODS: This was an observational study conducted over a period of one year (1.2.2016 to 31.1.2017) on all elderly patients presenting with encephalopathy. Their demographic profile along with clinical presentation, laboratory, imaging results and final outcome were recorded and analysed. RESULTS: There were 251 elderly patients who presented with encephalopathy, 110 (43.82%) of whom were females. Majority of these patients i.e. 186(74.10%) were in the age group of 60-75 years with a mean age of 70.78 years. There were 112 (44.62%) patients who presented to the hospital within 6 hours of commencement of the altered mental status (AMS). Multiple etiologies for encephalopathy were present in 75 (29.88%) patients with the commonest being neurological in 97 (38.65%) patients, infection/sepsis in 92 (36.65%) patients and metabolic in 84 (33.47%) patients. Hyponatremia was the commonest cause of metabolic encephalopathy present in 38(45.24%) patients followed by hypoglycemia in 25 (29.76%) patients. Pneumonia was the commonest infection present in 41 (44.57%) patients. There were 48(19.12%) deaths with 38(79.17%) of them having one or more co-morbidities. Early presentation to hospital (within 6 hours of commencement of symptoms), higher GCS and conscious level at presentation were the good prognostic markers of outcome in these elderly patients. However patients with septic encephalopathy were found to have worst prognosis. CONCLUSION: The common etiologies of encephalopathy in the elderly were neurological (38.65%) followed by infection (36.65%) and metabolic (33.47%). The mortality rate was 19.12%. Seeking medical aid within 6 hours of commencement of altered sensorium along with timely diagnosis could reduce the mortality and improve outcomes.

Ischemia Modified Albumin (IMA) - A Marker of Glycaemic Control and Vascular Complications in Type 2 Diabetes Mellitus.

INTRODUCTION: Ischemia modified albumin (IMA) has emerged as a marker for ischemic injury and oxidative damage, particularly in myocardial infarction. There are very few studies on the significance of IMA in other conditions associated with ischemia. The complications of diabetes mellitus (DM) arising out of poor glycaemic control have an underlying ischemic aetiology. AIM: To evaluate correlation of IMA with glycaemic control in type 2 DM (T2DM). Secondary aim was to assess the utility of IMA as a marker for vascular complications in T2DM. MATERIALS AND METHODS: During this cross-sectional study, a total of 100 diagnosed cases of T2DM were recruited between May 2013 and September 2013. The IMA, HbA1c, lipid profile, creatinine and urine micro-albumin levels were measured and analysed with respect to clinical condition of the patients. STATISTICAL ANALYSIS: The epidemiological software, Epi-Info 7.1.5, was used for the statistical analysis, p-value<0.05 was defined as level of significance. RESULTS: The study subjects were in the age group from 30 to 75 years and 52.4% were males. There was a great degree of variance in the level of glycaemic control and majority (64.6%) had poor or very poor glycaemic control as reflected by their HbA1c levels. The IMA (Mean ± SEM) levels were found to be higher (62.9 ± 1.7ABSU) in the patients with poor glycaemic control compared to those with good glycaemic control (54.2 ± 3.5 ABSU, p-value < 0.05) and correlated with HbA1c levels (r(2)=0.14). IMA levels also appeared to be related with the changes in lipid profile and increased with increasing total cholesterol levels. The subjects with macro-vascular complications (retinopathy and neuropathy) showed non-significantly higher levels of IMA. The elevation in IMA correlated with the HbA1c and changes in the lipid profile. CONCLUSION: IMA correlates with poor glycaemic control and dyslipidaemia associated with T2 DM and could serve as an indicator of oxidant stress in these patients.

Scrub typhus in Punjab: an acute febrile illness with multisystem involvement.

Scrub typhus is an important cause of acute febrile illness. This observational study describes the clinical features and complications of the patients diagnosed to have scrub typhus in Christian Medical College & Hospital, Ludhiana, Punjab, India. The diagnosis of scrub typhus was made by using Bioline SD Tsutsugamushi test kit which detects IgM, IgG or IgA antibodies to Orientia tsutsugamushi. Sixty-two patients of scrub typhus were seen during the study period of 1 year. The mean age of the study group was 39.9 years. All the patients presented with fever, and of these 31 (50%) had non-specific symptoms. All others had some complication, namely ARDS/ALI in 18 (29%), neurological involvement in 12 (19.4%), acute kidney injury (AKI) in 16 (25.8%), hypotension in eight (12.9%), thrombocytopenia in 23 (37.1%), hepatitis in 34 (54.8%) and MODS in 19 (30.7%). Eschar was present only in nine patients. Three patients expired due to multi-organ failure, hypotension and metabolic acidosis.