Descriptive Study to Assess Post-acute COVID-19 Complications in Patients Presenting at a Teaching Hospital in North India.

Introduction Coronavirus disease 2019 (COVID-19) caused by a novel coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported at the end of 2019 in Wuhan, Hubei Province, People's Republic of China, at a cluster of unusual pneumonia patients. The outbreak was declared a Public Health Emergency of International Concern on 30 January 2020 by World Health Organization. We are receiving patients in our OPD (Out Patient Department) with a new set of health complications having been infected with COVID-19. We planned to collect our data and try to find by various statistical methods, quantify the complications, and assess how we can deal with the new set of complications we are witnessing in this post-acute COVID-19 group of patients. Materials and methods The study was conducted by enrolling the patients at OPD/IPD (In Patient Department) by conducting a detailed history and clinical examination, routine investigations, 2D echocardiography (2D Echo), and pulmonary function test (PFT). The study assessed the worsening of symptoms, new onset symptoms, or the symptoms that continued even in the post-COVID-19 status as post-COVID-19 sequelae. Results Maximum cases were male and most of them were asymptomatic. The most common post-COVID-19 symptom that persisted was fatigue. 2D Echo and spirometry were done and changes were noticed even in those subjects who were asymptomatic. Conclusion Since significant findings were seen on clinical evaluation accompanied by 2D Echo and spirometry, it is essential to screen all presumed and microbiologically proven cases for long-term follow-up.

Dengue Encephalitis Versus Japanese Encephalitis in Cases of Dengue Fever With Altered Sensorium: A Diagnostic Dilemma.

Dengue and Japanese encephalitis (JE) are diseases that often conquer the top headlines in the leading newspapers during epidemics. Although recovery is the rule in most dengue cases, some unfortunately land up with multiple organ dysfunction syndromes, get critical, and even succumb to death. The main risk here is bleeding due to thrombocytopenia and platelet dysfunction. On the other hand, JE often presents with acute encephalitis syndrome (AES). We report a confirmed case of dengue (NS1 reactive, IgM dengue positive) by enzyme-linked immunosorbent assay (ELISA) who developed sudden onset altered sensorium. Non-contrast computed tomography (NCCT) head was done, which showed an infarct in the right gangliocapsular region with normal-sized ventricles. The patient had deteriorated in the past four days, which warranted a repeat NCCT head, revealing dilated ventricles and hemorrhagic transformation in the old infarct with surrounding edema. CSF viral markers were suggestive of IgM anti-JE virus positive. An MRI brain was planned but could not be done due to the deteriorating condition of the patient. Unfortunately, the patient landed up with multiple organ dysfunction syndrome and succumbed to death.

Type 2 Diabetes Mellitus in a Young Female Later Diagnosed as​​​​ Pancreatogenic Diabetes: The Dilemma in Classifying Diabetes Mellitus.

Diabetes mellitus type 3c (DM3c) is a diabetes caused by pancreatic pathology. It occurs due to the destruction of the endocrine islet cells. Diabetes diagnosed at the age of 20-30 years share a common dilemma in segregating between the type of diabetes the patient has, as its management varies depending on the type of diabetes the patient is harboring. However, insulin remains the treatment of choice in later decades as the pancreatic reserves of beta cells exhaust, although it takes decades to happen. We report a case of a woman who was diagnosed with diabetes mellitus at the age of 26, was on oral hypoglycemic agents (OHA), and was shifted to insulin therapy as she became non-responsive to OHA in a short span of six years, which was alarming. The patient presented to us with the chief complaints of recurrent abdominal pain that aggravated on taking meals and was associated with multiple episodes of vomiting for two months. Blood gas analysis on admission had no evidence of metabolic acidosis, urine ketones were negative, and a random blood sugar test (RBS:202) excluded the possibility of diabetic ketoacidosis. Serum amylase and serum lipase were within normal limits. Contrast-enhanced computed tomography (CECT) of the abdomen was suggestive of the atrophic pancreas with the non-dilated main pancreatic duct. Magnetic resonance cholangiopancreatography (MRCP) was done to rule out the congenital anomalies of the pancreas responsible for chronic pancreatitis, which showed no structural abnormalities. During our clinical workup, we postulated that the diabetes she was diagnosed with at the age of 26 was DM3c, i.e., pancreatogenic diabetes. The rapid shift of patients from OHA to subcutaneous insulin in a short span must be alarming to the physician managing diabetes and needs extensive workup to look upon the etiology of the same.