Effect of vitamin supplementation in patients of congestive heart failure deficient in vitamin D: A study at a tertiary care center of North India.

Introduction: Heart Failure is a leading cause of mortality worldwide including India. Most cross sectional studies have demonstrated heart failure is associated with deficiency of essential micronutrients including Vitamin D which may play a important role in pathogenesis of ventricular remodelling in heart failure. Aim: Our study performed aimed to determine the effect of supplementation in patients of Heart Failure presenting with Vitamin D deficiency to our institute on severity of Heart Failure. Design and Method: 97 patients of Heart failure coming to our institute were given conventional therapies for Heart Failure along with Vitamin supplementation based on serum Vitamin D levels and followed up for 3 months. Results: Patient of Heart failure having Vitamin D deficiency had significant reduction in cardiac biomarkers (NT-pro BNP levels), improvement in Left ventricular ejection fraction (LVEF) and more favourable reverse remodelling determined by Left ventricular end diastolic and systolic diameter (LVEDD & LVESD) though quality of life determined by WHODAS 2.0 score did not changed following 12 weeks supplementation of High Dose Vitamin D. Conclusion: Recognising and treatment of Vitamin D deficiency may determine long term prognosis in patients of Heart Failure.

RésuméIntroduction: L'insuffisance cardiaque est une cause majeure de mortalité dans le monde, y compris en Inde ... La plupart des études transversales ont démontré que l'insuffisance cardiaque est associée à une carence en micronutriments essentiels, y compris la vitamine D, qui peut jouer un rôle important dans la pathogenèse du remodelage ventriculaire dans l'insuffisance cardiaque.: Notre étude réalisée visait à déterminer l'effet de la supplémentation chez les patients souffrant d'insuffisance cardiaque présentant une carence en vitamine D à notre institut sur la gravité de l'insuffisance cardiaque. Conception et méthode: 97 patients atteints d'insuffisance cardiaque venant à notre institut ont reçu des thérapies conventionnelles pour l'insuffisance cardiaque ainsi qu'une supplémentation en vitamines basée sur les taux sériques de vitamine D et suivis pendant 3 mois. Résultats: Un patient souffrant d'insuffisance cardiaque et présentant une carence en vitamine D présentait une réduction significative des biomarqueurs cardiaques (taux de NT-pro BNP), une amélioration de la fraction d'éjection ventriculaire gauche (FEVG) et un remodelage inverse plus favorable déterminé par le diamètre diastolique et systolique du ventricule gauche (LVEDD & LVESD) bien que la qualité de vie déterminée par le score WHODAS 2.0 n'ait pas changé après 12 semaines de supplémentation en vitamine D à haute dose. Conclusion: la reconnaissance et le traitement d'une carence en vitamine D peuvent déterminer le pronostic à long terme chez les patients souffrant d'insuffisance cardiaque. Mots clés: Diamètre diastolique de l'extrémité ventriculaire gauche, fraction d'éjection ventriculaire gauche, NT-pro BNP, vitamine D, score WHODAS 2.0.

Hypereosinophilic syndrome presenting as eosinophilic gastroenteritis disorder and splinter hemorrhages: A case report.

BACKGROUND: Eosinophilia and related organ damage are extensively studied hot topics among rare disorders. Any addition to the cohort of available case reports of the same will be adding knowledge for better management of this less known entity. CASE SUMMARY: In this article, we describe a 27-year-old Indo-Aryan man who presented with abdominal pain, abdominal distension, and loose stools for variable days. He had splinter hemorrhages in the majority of fingernails. He was diagnosed with predominant eosinophilic gastrointestinal involvement with bowel obstruction and ascites, and was managed with intravenous immunoglobulin. He was subsequently treated with oral low dose steroid therapy and responded completely. CONCLUSION: Our experience is evidence that prompt management of this hypereosinophilic lethal gastrointestinal (all three layers) infiltrative disease provides a cure and avoids complications. Splinter nail hemorrhages may be seen in the same disease.

Paraquat poisoning in Andaman and Nicobar Islands - Government must intervene.

Paraquat poisoning is a grave public health problem in the Andaman and Nicobar islands of India. To evaluate various aspects of paraquat poisoning that influence the outcome, a retrospective study was planned. In this case series study, the information about all cases of acute paraquat poisoning who were admitted to GB Pant Hospital, Port-Blair, in a 12-year period (January 2007-December 2018) were evaluated. A total of 29 referred patients were evaluated with the majority from the early productive age of 16-30 years (68.97%). The case fatality rate was 100%. Most of the incidents took place in South Andaman district (68.97%) and during the rainy season (55.17%). Initially, they presented with local symptoms like mouth and throat pain with ulceration (48.27%), vomiting (44.82%), breathlessness (34.48%), epigastric and abdominal pain (31.03%), hematemesis (27.58%), and oliguria (20.68%). Later on, major organ dysfunctions like a respiratory failure (65.51%), acute kidney injury (62.08%), acute liver failure (55.17%), cardiac dysfunction (31.03%), and multiorgan failure (58.62%) ensued. Patients who were referred early had a significantly longer hospital stay. Few received advanced care, like, methyl prednisolone (24.12%), cyclophosphamide (10.34%), Mesna/NAC (06.89%), charcoal tablets (10.34%), mechanical ventilation (06.89%), and hemodialysis (10.34%). Apart from hemodialysis in acute kidney injury patients and steroid pulse, no other modalities showed improved hospital survival duration. Primary prevention especially government laws, public awareness, and education of health professionals regarding the seriousness of this problem are the keys to get rid of this incurable poisoning in these islands. The government should prioritize preventive works in the south Andaman district and during the rainy season to avoid catastrophe each year and if possible should ban it. Methyl prednisolone therapy and hemodialysis might be advocated to have a better outcome.

A coinfection of severe leptospirosis and scrub typhus in Indian Himalayas.

Scrub typhus and leptospirosis are zoonosis and systemic febrile illnesses with diverse, nonspecific clinical manifestations, and shared risk factors for coinfection. Diagnosis of the coinfection is dependent on laboratory serological tests, which are under used. A coinfection from Uttarakhand Himalayan region is not yet reported. A 25-year-old man from altitude of 2126 feet above sea level presented with fever, myalgia, jaundice, oliguria, mental confusion, and tender hepatomegaly. Investigations revealed leukocytosis, thrombocytopenia, impaired liver function tests, renal dysfunction with neurological involvement. Leptospira immunoglobulin IgM enzyme linked immunosorbent assay (ELISA) and scrub typhus immunochromatography test were positive. This coinfection is first to be documented in this holy Indian Himalayas. Clinical suspicion, early laboratory diagnosis, and early treatment could prevent complications and fatal outcomes. Coinfection of this type may be considered when there is persistence of fever and a treatment response to doxycycline.