Mortality in post-discharge COVID-19 patients from a tertiary care center - A follow-up study

Background: Among many responsibilities, the doctors from the COVID war room of our institute were assigned to take telephonic follow-up of discharged COVID patients to provide any medical assistance if needed. During this process, few relatives of the patient’s informed back that the patients had died after discharge from the COVID wards. Aim and Objective: Such data of death in the COVID patients after discharged are limited in India; hence, we conducted this study so that more information is generated. Materials and Methods: Relatives of these COVID patients were asked about date and place of death. Other data including gender, age, date of admission, date of discharge, and requirement of oxygen were available with the COVID war room and were used for evaluation. Results: Out of the 892 COVID discharged patients (between August and October 2020) who could be contacted, 19 (2.13%) patients (6 females and 13 males) had died after discharge from the COVID ward. Characteristics of these 19 patients included higher age (n = 11 were 61–80 years old and n = 3 were >80 years old), hospital stay of 11–20 days (n = 12), and required oxygen support (n = 12). Most deaths occurred within 20 days (n = 16) after discharge from the COVID ward. Conclusions: The current study reports deaths occurring COVID patients after discharge. Most of these deaths occurred within 4 weeks of cure and in elderly patients. More research with long-term follow-up is needed in “cured” COVID-19 patients so that appropriate preventive measures can be undertaken in the future.

Prevalence of familial hypercholesterolemia in premature coronary artery disease patients admitted to a tertiary care hospital in North India

Aims The prevalence of premature coronary artery disease (CAD) in India is two to three times more than other ethnic groups. Untreated heterozygous familial hypercholesterolemia (FH) is one of the important causes for premature CAD. As the age advances, these patients without treatment have 100 times increased risk of cardiovascular (CV) mortality resulting from myocardial infarction (MI). Recent evidence suggests that one in 250 individuals may be affected by FH (nearly 40 million people globally). It is indicated that the true global prevalence of FH is underestimated. The true prevalence of FH in India remains unknown. Methods A total of 635 patients with premature CAD were assessed for FH using the Dutch Lipid Clinical Network (DLCN) criteria. Based on scores, patients were diagnosed as definite, probable, possible, or no FH. Other CV risk factors known to cause CAD such as smoking, diabetes mellitus, and hypertension were also recorded. Results Of total 635 patients, 25 (4%) were diagnosed as definite, 70 (11%) as probable, 238 (37%) as possible, and 302 (48%) without FH, suggesting the prevalence of potential (definite + probable) FH of about 15% in the North Indian population. FH is more common in younger patients, and they have lesser incidence of common CV risk factors such as diabetes, hypertension, and smoking than the younger MI patients without FH (26.32% vs.42.59%; 17.89% vs.29.44%; 22.11% vs.40.74%). Conclusion FH prevalence is high among patients with premature CAD admitted to a cardiac unit. To detect patients with FH, routine screening with simple criteria such as family history of premature CAD combined with hypercholesterolemia, and a DLCN criteria score >5 may be effectively used.

Purification of heparin binding oviduct specific proteins and its effect on in vitro embryo development in cattle.

The objective of this study was to see the effect of purified heparin binding oviduct specific proteins (OSP) as media supplement on in vitro embryo developmental competence in cattle. The oviduct specific proteins were isolated from abattoir cattle oviducts and precipitated, dialyzed and at the end purified by high performance liquid chromatography system. The SDS-PAGE profile of eluted heparin binding protein (HBP) fraction showed bands between ~66 - ~97 kDa, while heparin unbinding protein (HUBP) fraction showed two bands at ~66 kDa and in total protein (TP) bands were ~60 - ~95 kDa. Collected all three OSP fractions were used as a media supplement in three different concentrations (0, 5 and 20 µg/mL) for in vitro maturation of immature oocytes, in vitro fertilization and culture of presumptive embryos at 38.5 ºC in 5% CO2 incubator with maximum humidity. The highest cleavage rate (73.40±2.36%) was observed at 5 µg/mL concentration level and lowest cleavage rate (27.63±1.89%) was obtained in 20 μg/mL total protein (TP) fraction. The highest blastocyst formation (26.47±1.47%) also occurred in 5 µg/mL concentration of total protein (TP) fraction and the lowest blastocyst rate (3.60±1.80%) was achieved at 20 µg/mL HBP fraction. The highest cleavage rate in the control group was 60.45±2.66% in TP fraction and blastocyst formation was 11.66±2.54% in HUBP fraction which was not significantly differ from HBP fraction. These results indicate that at 5 µg/mL of total OSP fraction (TP) and HBP used as media supplement increased the cleavage rate significantly as compared to HUBP fraction, and total OSP fraction (TP) increased blastocyst formation significantly (P<0.05) as compared to HBP & HUBP fraction.

Retrospective study of chikungunya outbreak in urban areas of India.

Background & objectives: A retrospective study on chikungunya outbreak in India in five States viz. Delhi, Madhya Pradesh, Orissa, Maharashtra and Kerala was conducted in 2007-2008 to know the distribution and determinants of chikungunya fever outbreak in India. Methods: On the basis of high and low incidence of chikungunya fever, two districts from each State and two wards from the selected district were taken for random selection of 1000 households from 10 districts and 5 States. Semi-structured questionnaires were administered to individuals, patients, qualified health professionals and to stakeholders for collecting information. Results: The educational background and occupation of the respondents showed variations across the study States. Only in high incidence ward of Maharashtra, water storage period for 3-6 days and emptying, drying of water containers on weekly basis was noted. The study through knowledge, attitude, belief, practice (KABP) obtained individual's perception of chikungunya fever, its prevention and control. Patients’ expenditure on treatment was mainly recorded less than Rs 500 across study States. Health facility survey obtained an overview of the capacity of local health facilities. Stakeholders’ perception regarding chikungunya fever was also noted. Interpretation & Conclusions: The study revealed differences in awareness of chikungunya, cause of the disease, vector responsible, mode of transmission, biting time and elimination of breeding of mosquitoes statistically significant among high and low incidence wards of all the States. Expenditure on treatment was independent of economically active status and loss of man-days across all the States. Education and occupation did not have any relation with emptying/drying of water containers in high incidence wards. Strengthening of surveillance, information, education and communication (IEC) activities along with case management facilities may be provided by the State health department for prevention of chikungunya outbreaks in future. Stakeholders should be more involved in outbreak management and future planning.

Management of severe and complicated malaria.

Severe malaria is invariably caused by Plasmodium falciparum. In India, both adults and children are affected by severe malaria. However, children are more prone for developing anemia and convulsions as manifestations of severe malaria, while acute renal failure and jaundice are more common among adults. Pregnant women are vulnerable to hypoglycemia, anemia and pulmonary complications. The case-fatality rate due to severe malaria is 10-15% in spite of therapy but it increases in the presence of renal failure or respiratory distress (pulmonary edema or ARDS). Of late, multi-organ failure and high mortality figures are being reported increasingly from different parts of India. Early diagnosis and prompt treatment will reduce the mortality due to malaria. Cerebral malaria should always be suspected in a patient with altered sensorium in a malaria-endemic area. However, other causes of unconsciousness such as encephalitis, meningitis or hepatic coma should also be excluded. Parenteral quinine is the mainstay of therapy. A recent multi-centric study has demonstrated the efficacy of intravenous artesunate in reducing the mortality by 30%. The usefulness of adjunct therapy is still controversial.

Evaluation of nimodipine in the treatment of severe diffuse head injury: a double-blind placebo-controlled trial.

AIMS: The aim of this study was to establish whether nimodipine given orally soon after severe diffuse head injury for a period of three weeks improved outcome. MATERIAL AND METHODS: The present report analyzes the results of a prospective randomized double-blind placebo-controlled trial of nimodipine in 97 severe head injury patients (GCS Score < or =8) treated at the Department of Neurosurgery, NIMHANS, between January 1995 and June 1996. The patients were randomly assigned to two groups which were matched for age, sex, mode of injury, time interval from injury to admission, neurological status and CT scan findings. One group was given nimodipine 30 mg Q6H and the other group was given a placebo. The outcome of these patients at 6 months was evaluated using the Glasgow Outcome Score by and a psychologist. RESULTS: Results showed no significant difference in the functional and psychological outcome between the two groups, even in patients with subarachnoid hemorrhage. No adverse drug events were recorded. CONCLUSION: Oral nimodipine given for three weeks does not improve outcome in patients with severe diffuse head injury.

Pulmonary autograft mitral valve replacement: initial experience with the Ross II procedure.

BACKGROUND: The renewed interest in mitral valve replacement with a pulmonary autograft encouraged us to perform this procedure in selected patients. METHODS AND RESULTS: From August 2000 to February 2002, 10 patients between 30 and 52 years of age with calcific mitral valvular disease underwent the Ross II procedure. Patients were either in New York Heart Association functional class III (7/10) or IV (3/10). Transthoracic echocardiography was done in all the patients to confirm the diagnosis. A pulmonary autograft was used to replace the diseased mitral valve. Intraoperative transesophageal echocardiography confirmed normal functioning of the autograft. There were 2 early deaths. The 8 survivors are in New York Heart Association functional class I with excellent autograft and homograft function at a follow-up of 2-20 months (mean 9 months). CONCLUSIONS: This procedure is a viable option for mitral valve replacement in patients with calcific mitral valve disease. However, the procedure is technically demanding and requires a valve bank.

Analysis of the activity of promoters from two photosynthesis-related genes psaF and petH of spinach in a monocot plant, rice.

The subunit III of photosystem I and ferredoxin-NADP(+)-oxidoreductase are encoded by nuclear genes, namely psaF and petH. The activity of their promoters from spinach has been evaluated in transgenic tobacco earlier. Evaluation of the activity of these Dicotyledoneae-specific promoters has been carried out in a monocot system (i.e. rice) by transient gene expression system, based on electroporation-mediated gene delivery into protoplasts from leaves and roots. It has been found that various promoter deletions show higher activity in leaf protoplasts and elements for quantitative response are widely distributed. Transgenic rice has also been produced with a petH promoter and gus reporter gene construct. Although petH promoter is a weak promoter in comparison to the 35S promoter, it expresses well in green tissues and could be useful for plant genetic engineering.

Immunochromatographic test for the diagnosis of Falciparum malaria.

The diagnosis of malaria poses great difficulty at times due to non-availability of microscope, trained personnel or laboratory set up. We undertook the immunochromatographic test in 98 suspected cases of malaria for the detection of antigen of P. falciparum in the blood and to assess its sensitivity and positive predictive value. The sensitivity was 87.06% (confidence interval 77.57 to 92.55%) and the positive predictive value was 93.67%. This is a simple, sensitive and convenient test which can be performed in remote areas.

Human carbonic anhydrase I: Effect of specific site mutations on its function.

Carbonic anhydrase I (CAI) is one out of ten CA isoenzymes that have been identified in humans. X-ray crystallographic and inhibitor complex studies of human carbonic anhydrase I (HCAI) and related studies in other CA isoenzymes identified several residues, in particular Thr199, GlulO6, Tyr7, Glull7, HislO7, with likely involvement in the catalytic activity of HCAI. To further study the role of these residues, we undertook, site-directed mutagenesis of HCAI. Using a polymerase chain reaction based strategy and altered oligonucleotide primers, we modified a cloned wild type hCAI gene so as to produce mutant genes encoding proteins with single amino acid substitutions. Thrl99Val, Thrl99Cys, Thr199Ser, GlulO6Ile, GlulO6Gln, Tyr7Trp, Glu.117Gln, and His I 07Val mutations were thus generated and the activity of each measured by ester hydrolysis. Overproduction of the Glu 117Gln and His I 07Val mutant proteins in Escherichia coli resulted in a large proportion of the enzyme forming aggregates probably due to folding defect. The mutations Thr199Val, GlulO6Ile and GlulO6Gln gave soluble protein with drastically reduced enzyme activity, while the Tyr7Trp mutation had only marginal effect on the activity, thus s.uggesting important roles for Thr199 and GlulO6 but not for Tyr7 in the catalytic function of HCAI.

Posterior fossa extradural haematoma.

Seventeen patients with posterior fossa extradural haematoma are presented. While 7 patients had acute course, 6 had subacute and 4 had chronic course. All patients had evidence of occipital injury. Two patients did not have any fracture in the occipital bone. Concomitant lesions included cerebellar contusion in 3 cases, cerebral contusion in 4 patients, supratentorial extradural haematoma in 2 and hydrocephalus in 2 patients. All but one patient were treated surgically. None of the supratentorial lesions were operated upon. All patients with subacute and chronic course had good outcome while 43% with acute course succumbed to death. Besides the initial clinical status the co-existing lesions signifying the increased severity of injury have influenced the mortality and quality of outcome. In presence of occipital fracture a careful observation and timely intervention are warranted.

An unusual orbito-cranial foreign body.

The rarity of orbito-cranial gun shot injury in both war and civilian practice has been reported. In a large series of 351 missile head injuries in the Vietnam war, orbital penetration was noted in 0.6% cases only. Review of literature shows that orbital injury was ipsilateral to the cerebral injury in most reported cases. We have previously reported a rare case of left parieto-occipital lobe injury due to gun shot wound of the contralateral (right) orbit. The case reported here sustained a bullet injury to the left frontal bone but the missile was located below the contralateral (right) optic canal. The rarity of the case prompted this report.

Giant aneurysm of internal carotid artery presenting features of retrobulbar neuritis.

We report the case of a man who presented with in the features of left optic nerve compression. CT scan and carotid angiography demonstrated an unruptured giant aneurysm of the left internal carotid artery possibly kinking the optic nerve. Carotid ligation in the neck saved both life and vision.

Orbital reconstruction in fibrous dysplasia--a case report.

A case of orbitofrontal fibrous dysplasia with optic canal involvement is reported. Surgical excision of the mass with unroofing of the optic canal followed by orbito-cranian reconstruction by methyl methacrylate gave excellent results.

Atypical Wilson disease--a case report with CT scan.

A case of atypical Wilson disease is being reported. Possible mechanism of the process, diagnostic features and CT appearance of brain is described. Early detection and therapy with copper chelating agents result in neurologic and performance improvement of patients.