Tenofovir-induced distal renal tubular acidosis: A rare cause of recurrent hypokalaemic paralysis.

Tenofovir disoproxil fumarate was the first nucleotide analogue reverse transcriptase inhibitor to be approved for treatment of human immunodeficiency virus infection. It is a relatively safe drug but can present with nephrotoxicity. We report a case of 36-year-old male who presented with acute onset flaccid paraparesis. He was a diagnosed case of acquired immunodeficiency syndrome for 9 years ago and was on tenofovir-based antiretroviral therapy for last 6 months. As the patient had normal anion gap metabolic acidosis, hypokalaemia and urine pH > 5.5, distal renal tubular acidosis (RTA) was suspected. He improved dramatically within 24 h of hospitalisation after potassium correction to regain normal power. Tenofovir-induced distal RTA presenting as hypokalaemic paralysis is a very rare complication of tenofovir; hence, we are reporting this case. In addition, we suggest regular follow-up of patients taking tenofovir with urine analysis and serum potassium to detect this complication earlier as it is reversible.

A Comparative Study of Absolute Lymphocyte Count (Alc), Neutrophil Lymphocyte Ratio (Nlr) and Red Cell Distribution Width (Rdw) among Covid 19 Death and Survival Group.

At the end of 2019, a novel coronavirus was identified as the cause of a cluster of pneumonia cases in Wuhan, a city in the Hubei Province of China. It rapidly spread throughout the world. Identifying patients at highest risk for severe disease is important to facilitate early, aggressive intervention and to mitigate the crises occurring throughout the world. Biomarkers were needed for patient stratification into those likely to develop severe disease and with high risk of mortality. Present study aims to find out those indicators. MATERIAL: Total patients admitted over a period of 1 year from 1st April 2020 to 31th March 2021 in Dedicated COVID Hospital of RNT Medical College and MB hospital Udaipur was 4304 out of which 620 died and 3498 got discharged, 186 couldn't be followed up as they took leave against medical advise. From death group (620 patients) and Survival group (3498 patients), 400 patients were selected randomly from each group and were analysed and comparison was made between both the groups including parameters like ALC(Absolute lymphocyte count), NLR(Neutrophil Lymphocyte)ratio and RDW(Red cell distribution width). OBSERVATION: Median age in death and survival group was 62.03 and 47.18 respectively. Mean Absolute lymphocyte count was 0.88 and 0.93 in death and survival group respectively. Mean Neutrophil -Lymphocyte ratio in death and survival group was 8.37 and 4.34 respectively. Mean RDW- CV was 1.86 and 1.67 in death and survival group respectively. CONCLUSION: From the present study we conclude that Decreased ALC and Elevated NLR are a reliable indicator of death as an outcome in COVID 19 disease whereas RDW was high in COVID19 patients but had no significant relationship with outcome of the disease.

Epidemiology, Clinical Presentation, Lab Diagnosis and Outcome of Scrub Typhus Outbreak in a Tertiary Care Center in Southern Rajasthan.

Scrub typhus is also known as tsutsugamushi disease or bush typhus. It is a mite-borne acute febrile illness caused by Gram-negative intracellular organism called Orientia tsutsugamushi, which belongs to the family of Rickettsiaceae. The aims and objectives are to study the epidemiological patterns, different clinical manifestations and complications associated with scrub typhus. MATERIAL: This was a prospective study which was carried out over a period of 12 months from January 2019 to December 2019 in patients of scrub typhus admitted in various medical wards of MB Govt. Hospital and RNT Medical College, Udaipur, Rajasthan. OBSERVATION: All the patients admitted with history of acute febrile illness suspected to be scrub typhus were assessed in the study. All these patients were evaluated by the set protocol in the form of detailed history, physical examination and relevant systemic examination. A total of 3,814 suspected patients of scrub typhus were tested in our microbiology laboratory and 1,340 patients were reported positive. Out of these, only 480 patients who were admitted in our medical wards were enrolled in our study and evaluated. CONCLUSION: We conclude that in rural Rajasthan, any patient who presents with fever, myalgia, hepatosplenomegaly and multiorgan dysfunction syndrome, a diagnosis of scrub typhus should be suspected.