An analysis of mortality and survival of COVID 19 patients admitted to a tertiary care hospital in Maharashtra, India.

BACKGROUND: After nine months of responding to the coronavirus disease-19 (COVID-19) pandemic, the scientific fraternity is yet to unravel the mystery of those who are at most risk from mortality. Despite resistance to wear masks, the global public health response has beaten the grimmer projections of millions of deaths. The present study seeks to analyze the survival of COVID-19 patients at a tertiary care hospital and identify the risk factors of mortality. METHODS: Medical records of 1233 RT PCR confirmed COVID-19 patients admitted in a tertiary care hospital between 01 April and 30 September 2020 were retrospectively analyzed for calculating overall survival and to investigate the independent predictors of survival of COVID-19 patients. RESULTS: There were 72 (5.8%) deaths; which occurred in 24.9% of the elderly (age > 60yrs) people (P < 0.001), 76.0% in people with multiple comorbidities (having more than one comorbidity) (P < 0.001), 75.6% in people with diabetes (P < 0.001), and 75.5% in people with hypertension (P < 0.001). A significantly higher risk of mortality was observed in elderly patients, patients with comorbidities, and patients requiring oxygen while admitted in the hospital. CONCLUSION: Survival reflects the cure rates and is used by health professionals and policymakers to plan and implement disease control measures. The insights provided by the study would help facilitate the identification of patients at risk and timely provision of specialized care for the prevention of adverse outcomes in the hospital setting.

Low backache in adults as an initial presentation of acute lymphoblastic leukemia.

Low backache as an initial manifestation of acute lymphoblastic leukemia (ALL) in adults has been rarely reported. In this hematological disorder, although bone marrow is replaced by malignant cells, not many cases of low backache as an initial presentation of ALL are reported. We present a series of clinical cases with low backache, which on evaluation found to have ALL.

Unusual complication of prolonged indwelling urinary catheter - iatrogenic hypospadias.

Long-time urethral catheterization may be responsible for various complications such as urethral stricture, urethral fracture, urinary tract infections, and hypospadias. Hypospadias is the most common congenital anomaly of male external genitalia. However, urethral catheter-induced iatrogenic hypospadias is a rare entity. In this article, we describe a case of an elderly male who was found to have iatrogenic hypospadias 2 months after urinary catheterization.

Urinary catheterization from benefits to hapless situations and a call for preventive measures.

Catheter-associated complications are common, expensive, and often preventable by reducing unnecessary catheter usage. These complications range from most common nosocomial infection to uncommon conditions such as urethral diverticula and ischemic necrosis of the penis. Often, removal of a single known essential cause may be sufficient to prevent a disease. This review raises issues associated with urinary catheterization and emphasizes on the need of preventive measures a physician should take to reduce disappointing situations. The main objective of this literature review is to intercept or oppose unwanted catheter use and thereby, the disease processes associated with urinary catheterization. There is well-described literature available on catheter-associated urinary tract infection, but little is known about noninfectious complications resulting from catheter use; therefore, we also tried to draw attention on these unusual complications.

Mantle cell lymphoma of the oral cavity with multiple foci: a case report and review of the literature.

Non-Hodgkin lymphomas (NHLs) are often present outside the lymph nodes. Although primary extranodal NHLs form a substantial part of all NHLs, reports on oral primary extra nodal NHLs are rare. Mantle cell lymphoma (MCL) is a rare B-cell neoplasm that has only recently been defined as a distinct entity. MCL of the oral cavity is an uncommon diagnosis. Most oral MCLs occur in an elderly male population and have a possible predilection for the palate. The microscopic diagnosis can be challenging, given its similar appearance to other small cell lymphomas, requiring a comprehensive immunohistochemical panel for the accurate diagnosis. Like MCL occurring in other sites in the body, the prognosis and outcome of oral MCL appears to be poor.

Steroid unresponsive case of ulcerative mucha-habermann disease (febrile ulcernecrotic mucha-habermann disease) treated with methotrexate.

A 20 year old male presented with fever associated with eruption of papules, plaques and vesiculobullous lesions on the chest, back, extremities, palms, soles, and genital mucosa of 20 days duration. Histopathological examination revealed epidermal clefts, edema and vacuolar degeneration of keratinocytes, basal cell degeneration, and dermal perivascular lymphocytic infiltrate. On the basis of clinical features and histology, a diagnosis of febrile ulceronecrotic Mucha-Habermann disease (FUMHD) was made. Treatment with doxycycline (100 mg BD for 4 weeks) and oral prednisolone 60 mg/day tapered to 25 mg in 4 weeks led to initial response that was followed by a relapse on tapering steroid. Addition of methotrexate (7.5 mg increased to 15 mg in 2 weeks) led to a dramatic response.

Ectopic thymoma with pure red cell aplasia--ambiguity with indolence.

Two cases of thymomas with pure red cell aplasia (PRCA) are presented, highlighting variability in their anatomic location, ambiguity in presentation, indolence of course and unpredictability of response to treatment. Multi-modality approach is necessary for both diagnosis and management of this combination. Duration and side effects of treatment determine the overall prognosis.

Head and neck histoplasmosis--a nightmare for clinicians and pathologists! Experience at a tertiary referral cancer centre.

Histoplasmosis is a rarely reported deep mycotic infection in the Indian context. Oral or oropharyngeal manifestation can occur as an isolated symptom or as part of a disseminated process associated with immunosuppression especially with HIV and diabetes. Five cases of head and neck histoplasmosis accrued over 6 years in a tertiary referral cancer institute were reviewed. All these patients presented clinically as cancer. In three patients, the marked pseudoepitheliomatous hyperplasia led to a mistaken biopsy diagnosis of malignancy following which definitive surgical treatment was performed. The subsequent excision revealed typical features of histoplasmosis. Isolated oral presentation of histoplasmosis can mimic malignancy both clinically as well as pathologically, leading to potentially disastrous consequences. A high index of suspicion in those with overt or hidden immunosuppression and a deep wedge biopsy to demonstrate the organisms in the subepithelial tissue is recommended.