Transient reactive phlebitis and intravenous ciprofloxacin: Is there an association?

Transient reactive phlebitis (TRP) is a rare adverse event seen with intravenous infusion of medications. It is characterised by the appearance of erythematous cord-like lesions along the superficial veins proximal to the site of infusion. It is rarely seen with drugs such as morphine, rocuronium, eptifibatide, propofol and vancomycin. The exact pathogenesis is not clear; however, certain proposed mechanisms are due to the direct activation of C-nociceptors, activation of the kallikrein-kinin system with bradykinin release, local mediator release or histamine release. Here, we report a case of TRP due to ciprofloxacin infusion.

A study to assess the outcome in COVID-19 confirmed cases receiving Remdesivir as compared to conventional therapy: Medical records-based audit.

Introduction: COVID-19 infection caused by SARS-Corona virus-2 (SARS-CoV-2) has caused large number of infections and mortality globally. There are no proven medications to prevent and treat COVID-19, nevertheless several potential pharmacotherapeutic agents have been tried. Remdesivir was found to be effective in few studies. Aims: To assess the outcome in COVID-19 confirmed cases receiving Remdesivir as compared to conventional therapy. Methodology: This study was conducted in a tertiary hospital in South India after the approval of the Institutional ethical committee. It was a medical records-based retrospective, longitudinal study. Medical records of the inpatients with confirmed COVID-19 infection were reviewed from the period of June 15, 2020 to September 15, 2020. This study was conducted to assess the clinical and laboratory profile and outcome in the patients admitted with moderate and severe COVID-19 disease who received Remdesivir. Statistical Analysis: The analysis was done using SPSS Inc. released 2009, PASW statistics for Windows version 18.0, Chicago. Results: One hundred eleven (N = 111) patients were included in the study. 56 patients received the conventional treatment (Hydroxychloroquine HCQ) and 55 patients received Remdesivir. It was seen that among patients treated with HCQ, 24 (42.9%) required non-invasive ventilation and seven (12.7%) patients treated with Remdesivir required it (P = 0.001). It was noticed that the mean duration of hospitalization was 16.6 days in HCQ group and was 11.4 days in Remdesivir group (P = 0.021). Conclusion: The study demonstrates that Remdesivir does have benefit in reducing the mortality and duration of hospital stay. There was reduced requirement of non-invasive and invasive ventilation among patients treated with Remdesivir.

A Study of the Association Between Metabolic Syndrome and Vitamin D Deficiency.

Metabolic syndrome is a global pandemic. It contributes to early cardiovascular morbidity and mortality. The etiology of Metabolic Syndrome is not completely well understood yet. Insulin resistance remains the most accepted hypothesis. Another such hypothesis is that of vitamin D deficiency. Exploring a possible association between these two highly prevalent conditions could help in better understanding of the pathophysiology of metabolic syndrome. The clinical impact of this association could help in better control of the health of an individual if lifestyle and pharmacological interventions for Metabolic Syndrome fail. MATERIAL: In this cross sectional study, 176 consecutive patients were enrolled. The patients were divided into two groups- cases and controls on the basis of the NCEP ATP III criteria. History, clinical examination and laboratory tests like FBS, fasting lipid profile and vitamin D were done for both the groups and results were compared. OBSERVATION: The mean serum vitamin D levels among those with Metabolic Syndrome was lower, 16.50 +/-9.06 ng/ ml compared to those without the syndrome, 20.75 +/- 10.29 ng/ml. This difference was found to statistically significant (p = 0.004) signifying a strong association. FBS and waist circumference showed a significant negative correlation while exposure to sunlight and HDL had a significant positive correlation with vitamin D deficiency. CONCLUSION: In this study, mean vitamin D levels were lower in those with metabolic syndrome than those without metabolic syndrome and this was found to be statistically significant. Thus in patients of Metabolic Syndrome with poorly controlled metabolic parameters despite adequate lifestyle and pharmacological interventions, correction of the vitamin D, if found to be deficient, can be considered for better control of these parameters.

Clinical and Laboratory Profile of Patients Visiting the Post-COVID-19 Clinic at a Tertiary Care Hospital: A Cross-Sectional Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) survivors may continue experiencing diverse symptoms. This study portrays the clinical and laboratory profile of patients with post-acute sequelae of COVID-19'(PASC) at a tertiary care hospital in India.  Methodology: This cross-sectional study enrolled patients visiting the post-COVID-19 clinic three weeks after their acute COVID-19 illness. Their clinical, serological, and radiological characteristics were collected and analyzed. RESULTS: Of the 259 participants (age: 48.02±15.27 years; 62.25% men), 168 had PASC manifestations. The most frequently reported symptoms were fatigue (n=71(42.26%)), breathlessness (n=38(22.61%)), and cough (n=35(20.83%)). Patients with PASC had higher body mass index (28.24±5.02 vs. 26.26±3.65; p=0.002), history of hypertension (52 (30.95%) vs. 17 (18.6%); p=0.039), uncontrolled systolic blood pressure (37 (22.03) vs. 14 (15.38); p=0.042), and persistent chest x-ray abnormalities (34 (20.23) vs. 10 (10.98); p=0.048). CONCLUSION: Fatigue, breathlessness, and cough are common PASC symptoms. Hypertension, obesity, and abnormal chest x-ray findings at follow-up are potential risk factors for developing PASC.

Endobronchial tuberculosis: two case reports and review of the literature.

Endobronchial tuberculosis commonly affects young patients and presents as acute or insidious onset cough, wheeze, low grade fever, and constitutional symptoms. Although endobronchial lesions usually result in sputum positivity for acid fast bacilli (AFB), a false negative sputum or absence of radiological lesions may result in delayed diagnosis. On the other hand, sputum positivity with presence of signs on chest radiology may lead to consideration of parenchymal TB as the primary diagnosis and the coexistence of endobronchial lesions may be missed until sequelae of the latter ensue. Besides, in elderly patients, consideration of other differentials like malignancy and pneumonia may lead to misdiagnosis. Hence, bronchoscopy is essential for confirmation of endobronchial TB. We hereby report two cases of endobronchial TB which stress the importance of bronchoscopic diagnosis for timely institution of treatment and prevention of permanent sequelae, respectively.