Clinical features, laboratory characteristics and risk factors for mortality of COVID-19 patients in a secondary hospital in Oman during the first wave of the SARS-CoV-2 pandemic.

Background: The changing epidemiological profile of the COVID-19 pandemic and the uncertain clinical picture of patients characterise this ongoing and most challenging health event. Objectives: To report clinical features, laboratory characteristics, and mortality risk factors among COVID-19 patients admitted to a secondary hospital in Oman. Methods: A retrospective study for the first 455 patients admitted with COVID-19 to Rustaq hospital from 12th April, 2020 to 27th September, 2020. A predesigned questionnaire collected data from the hospital medical electronic system. Results: The mean age was 42.84 (SD = 19.86) years, and the majority of patients were aged 30 to 59 and 60 or above; 207 (45.5%) and 189 (41.5%), respectively. Male patients constituted approximately two-thirds of the subjects. Fever, dyspnea and cough were the most common presenting symptoms (69%, 66%, and 62%, respectively), while comorbidities with diabetes mellitus and hypertension were 47% and 44%, respectively. Bacterial growth was identified at approximately 10%. Bivariate analysis turned out to be significant with a number of factors. However, multivariate analysis showed significance with patients aged over 60 (OR = 7.15, 95% CI 1.99-25.63), dyspnea (OR = 2.83, 95% CI 1.5-5.33), dyslipidemia (OR = 1.93, 95% CI 1.02-3.66) and being bed-ridden (OR = 5.01, 95% CI 1.73-14.44). Durations from onset of symptoms to admission and respiratory distress were lower among patients who died; p = 0.024 and p = 0.001, respectively. Urea, Troponin and LDH may act as potential diagnostic biomarkers for severity or mortality. Conclusions: This study identified groups of patients with a higher risk of mortality, with severe disturbance in the laboratory markers while some could act as potential diagnostic biomarkers.

Risk factors for early onset severe pre-eclampsia and eclampsia among north Indian women.

A case-control study was conducted in India between April 2007 and January 2008, to identify the clinical and historical risk factors associated with early onset pre-eclampsia/eclampsia (PE-E) in women attending a tertiary care hospital in North India. The study group comprised 100 women with early onset severe pre-eclampsia/eclampsia (≤34 weeks) and a control group of 100 women with mild non-proteinuric hypertension (>34 weeks). A detailed history including past, personal and family history, pregnancy outcome including delivery details and perinatal outcome and available investigations were recorded in a pre-designed proforma. Multiple logistic regression analysis was used to determine the risk factors for pre-eclampsia. The risk factors that were associated with increased risk of early onset severe PE-E were: history of PE-E in a previous pregnancy (adjusted odds ratio, aOR 71.40); exposure to passive smoking (aOR 16.40); inadequate antenatal supervision (aOR 15.21); family history of hypertension in one or more 1st-degree relative (aOR 8.92); living in a joint family (aOR 6.93); overweight (>120% to 150% of pre-pregnancy ideal body weight, aOR 4.65) and lower socioeconomic class (Kuppuswamy's class III-V) (aOR 3.00). Based on the above risk factors, a risk model can be constituted as practised in other places and implemented in the primary preventive measure of early-onset severe pre-eclampsia among the North Indian women attending this tertiary care hospital.

Post COVID-19 Syndrome ("Long COVID") and Diabetes: Challenges in Diagnosis and Management.

BACKGROUND AND AIMS: Post Covid-19 syndrome (PCS) is a major cause of morbidity. In this article we intend to review the association and consequences of PCS and diabetes. METHODS: We reviewed all studies on "Long Covid", "Post COVID-19 Syndrome" and diabetes in PubMed and Google Scholar. RESULTS: The symptoms of PCS can be due to organ dysfunction, effects of hospitalisation and drugs, or unrelated to these. Type 2 diabetes mellitus has a bidirectional relationship with COVID-19. Presence of diabetes also influences PCS via various pathophysiological mechanisms. COVID-19 can add to or exacerbate tachycardia, sarcopenia (and muscle fatigue), and microvascular dysfunction (and organ damage) in patients with diabetes. CONCLUSION: PCS in patients with diabetes could be detrimental in multiple ways. Strict control of diabetes and other comorbidities, supervised rehabilitation and physical exercise, and optimal nutrition could help in reducing and managing PCS.

Long COVID: An overview.

BACKGROUND AND AIMS: Long COVID is the collective term to denote persistence of symptoms in those who have recovered from SARS-CoV-2 infection. METHODS: WE searched the pubmed and scopus databases for original articles and reviews. Based on the search result, in this review article we are analyzing various aspects of Long COVID. RESULTS: Fatigue, cough, chest tightness, breathlessness, palpitations, myalgia and difficulty to focus are symptoms reported in long COVID. It could be related to organ damage, post viral syndrome, post-critical care syndrome and others. Clinical evaluation should focus on identifying the pathophysiology, followed by appropriate remedial measures. In people with symptoms suggestive of long COVID but without known history of previous SARS-CoV-2 infection, serology may help confirm the diagnosis. CONCLUSIONS: This review will helps the clinicians to manage various aspects of Long COVID.

Management Strategies for Dealing With Surges of the COVID-19 Pandemic.

The spread of COVID-19 (coronavirus disease 2019) across the world has resulted in widespread morbidity and mortality. An explosive increase in the number of cases during the surge phase of the pandemic can result in a management crisis. Therefore, we propose a simple model to manage the surges of the pandemic.

A new interventional home care model for COVID management: Virtual Covid IP.

AIM: Amidst COVID-19 pandemic, the health care delivery in India faces major challenges owing to the overwhelming hospitals, exhausted healthcare workers, and shortage of crucial medical supplies such as ventilators and oxygen. The study aims to propose a novel successful interventional home care model, the Virtual COVID In-Patient (VCIP) care for effective COVID management. METHODS: The Covid-19 positive patients enrolled in VCIP were chosen for the study. A 24/7 active multidisciplinary WhatsApp group was created for each patient, for remote monitoring of temperature, blood pressure, blood glucose, respiratory and pulse rate along with the symptoms. Advice on sleep and exercises were given along with the medication via video-audio consultations. Lab facility was provided at the doorstep. Training on various devices, medications including steroids, delivering subcutaneous injections etc were given via video platforms. RESULTS: Among the 220 patients who availed the VCIP facility, only two were hospitalized, yielding a 99.5 % success rate in preventing hospitalizations and patients enrolled have been immensely satisfied with their experience. CONCLUSIONS: With similar pandemics anticipated in near future, VCIP model may be considered for successful domiciliary treatment and overcoming the challenges.

Severe anaemia in pregnancy: a tertiary hospital experience from northern India.

Anaemia is a major health problem among woman of reproductive age group, particularly in developing countries. We undertook this study to determine the maternal and perinatal outcome in patients with severe anaemia in pregnancy, with a haemoglobin concentration of < 7 g/dl. The in-hospital data were analysed for 12 months between January 2007 and December 2007 and 2.15% (n = 96) of women were found to have severe anaemia. Out of these, 18.75% had pre-term premature rupture of membranes and 5.12% of all deliveries were pre-term. Hypertensive diseases of pregnancy were seen in 17.7%; abruption in 3.12% and 9.37% had congestive cardiac failure. Postpartum haemorrhage was seen in 25.5% of the patients and 8.33% had puerperal pyrexia. Fetal distress was seen in 26% of and 33.33% had small for gestational age neonates; there were 16.66% stillbirths and 4.16% neonatal deaths. Of the 96 severely anaemic women, six died after admission. Our study shows that efforts must be taken towards safe motherhood and spreading awareness about the various consequences of anaemia, which is usually preventable with early correction.

Advanced germ cell malignancies of the ovary: should neo-adjuvant chemotherapy be the first line of treatment?

Malignant germ cell tumours of the ovary, though classically known for 'young age' and 'early stage' at presentation, are not uncommonly identified at advanced stages. Little is available in literature on the role of neo-adjuvant chemotherapy (NACT) in this group of tumours. Two patients with advanced stage ovarian germ cell tumours, including one with 45XO/46XY chromosomal mosaicism, were treated at our Institute with neo-adjuvant chemotherapy with Bleomycin, Etoposide and Cisplatin followed by surgery. Besides marked clinical improvement, intraoperatively both the patients presented no difficulty otherwise expected with widespread tumours, and histopathology report revealed no evidence of viable tumour. The article discusses the experience and suggested course of management of these tumours with NACT, which could be offered to patients with advanced malignancy in whom high surgical morbidity is anticipated or in whom only an operative biopsy was performed at laparatomy. Behaviour and management guidelines of dysgenetic gonads with XY mosaicism have also been discussed.

Does a younger host make the virus weaker? Presenting a new hypothesis.

BACKGROUND: COVID-19 is a pandemic, resulting in large number of deaths all over the world. METHODS: The risk factors for mortality are not clearly understood. We are presenting a new hypothesis. RESULTS: Virus become more virulent as it passes through weaker hosts and vice versa. CONCLUSIONS: Viruses become more virulent when it passes through weaker and older hosts. It will be worth analysing the transmission chain of COVID-19 from this perspective.

Reverse quarantine and COVID-19.

BACKGROUND: COVID-19 is a pandemic, resulting in large number of deaths all over the world. Lack of effective antiviral agents and vaccines pose a major challenge to control this pandemic. METHODS: Review the role of reverse quarantine in the control of COVID-19. RESULTS: Public health measures like social distancing, wearing face mask and hand hygiene along with quarantine measures form important steps to control the disease. Reverses quarantine is a useful strategy to reduce morbidity and mortality associated with COVID-19. CONCLUSIONS: Reverse quarantine is a promising public health measure to reduce the morbidity and mortality associated with COVID-19.

An Adolescent with Progressive Enlargement of Digits: Case report and proposed diagnostic criteria for macrodystrophia lipomatosa.

Macrodystrophia lipomatosa (ML) is a rare congenital non-hereditary condition caused by an increase in all mesenchymal elements. We report a 14-year-old girl who presented to the Medical Outpatient Department, Kunhitharuvai Memorial Charitable Trust Medical College, Kozhikode, India, in 2017 with progressive enlargement of digits. An X-ray and T1-weighted magnetic resonance imaging scan showed enlargement of the phalanges of the middle and index finger of the left hand with an overgrowth of soft tissues. The patient was subsequently diagnosed with ML. As the condition is benign and usually asymptomatic, no medical treatment was deemed necessary. This report describes a case of ML and proposes a set of diagnostic criteria to aid clinicians in the differential diagnosis of the condition.

Diabetes control during Ramadan fasting.

For diabetic patients, fasting during Ramadan, the ninth month of the Islamic calendar, can cause wide fluctuations in blood sugar levels, posing a medical challenge for patients and physicians and increasing the risk of acute metabolic complications including hypoglycemia, hyperglycemia, diabetic ketoacidosis, dehydration, and thrombosis. Proper patient education, risk stratification, and modification of antidiabetic medications can reduce the risk of complications.

Incretin manipulation in diabetes management.

Incretin-based therapies have revolutionized the medical management of type 2 diabetes mellitus (T2DM) in the 21(st) century. Glucagon-like peptide-1 (GLP-1) suppresses appetite and gastric motility, and has trophic effects on pancreas, cardio-protective and renal effects. GLP-1 analogues and dipeptidyl peptidase-4 inhibitors form the incretin-based therapies. Significant reduction of hemoglobin A1c when used as monotherapy and in combination regimens, favorable effects on body weight, and low risk of hypoglycemia are their unique therapeutic benefits. Their safety and tolerability are comparable to other anti-diabetic medications. Concern about elevated risk of pancreatitis has been discarded by two recent meta-analyses. This article discusses the therapeutic manipulation of incretin system for the management of T2DM.

Formulation and evaluation of polyherbal hair care powders.

The formulation of polyherbal hair care powders was attempted in our laboratories. There formulation (A-C) were found to be ideal and evaluation of these formulations is reported here.