Persisting and New Onset Symptomatology and Determinants of Functional Limitation of Post Acute COVID-19 Syndrome Cases- A Study from a Northern District of Kerala.

Background: COVID-19 disease has a wide range of persisting and new onset clinical manifestations even long after the acute phase. This study was conducted to identify the persisting and new onset symptomatology of post-COVID-19 syndrome patients from clinics in urban and peri-urban Kozhikode, South India, as well as to grade their functional limitation; assess the determinants and predictors. Material and Methods: A cross-sectional study was conducted among 938 subjects attending the post-COVID clinics. Symptom profile, functional assessment, and limitation grading were done using the Post-COVID-19 Functional Status (PCFS) scale. Statistical analyses were done using the SPSS ver.20. Results: Mean age was 41.50 ± 16.90 years. Fever, anosmia, dysgeusia, headache, and myalgia were the common acute COVID-19 symptoms (505,54%; 433,46.3%; 420,44.9%; 323,34.4%; 252,26.9%, respectively). Post-COVID-19, common persisting symptoms were myalgia (167,17.8%), fatigue (149,15.9%), dyspnea (113,12%), and headache (85,9.1%); the common new onset symptoms were shortness of breath and fatigue (228,24.3% and 220,23.4%, respectively). A total of 91 cases (9.7%) had post-COVID sleep disturbances; 16 (1.7%) had symptoms of anxiety and depressive thoughts. PCFS grading showed that 552 (63.8%) had negligible limitations (Grade I). Only one person had Grade IV limitation. Significant association (p < 0.05) was found between functional impairment grading by PCFS and age, gender, locality, type of family, duration of hospitalization, duration of unemployment following illness, source of infection, diabetes mellitus, and hypertension. Male gender, married status, CAD, and smoking had significant higher risks; urban locality and hospitalization decreased the risk. Conclusions: SARS-CoV-2 cases have persistent and new onset symptoms and some degree of functional impairment post-COVID. Significant association was identified for various sociodemographic and clinical variables with the PCFS functional impairment grading.

Linear trends over 20 years in sexually transmitted infections among patients attending a tertiary care centre in north Kerala, India.

BACKGROUND: Worldwide, a declining trend is observed in sexually transmitted infections of bacterial origin which is reflected as a rise in the proportion of viral sexually transmitted infections. AIMS: To find out the clinical referral patterns of sexually transmitted infections among patients who attended the sexually transmitted infection clinic attached to Dermatology and Venereology Department of Government Medical College, Kozhikode from 1.1.1998 to 31.12.2017 and to study the linear trends in the pattern of sexually transmitted infections over 20 years. METHODS: After clearance from the institutional ethics committee, a retrospective study was conducted among patients who attended the sexually transmitted infection clinic of Government Medical College, Kozhikode from 1.1.1998 to 31.12.2017 and were diagnosed to have sexually transmitted infections. RESULTS: During the 20 year study period 5227 patients, attended the sexually transmitted infection clinic of our institution. Diagnosis of sexually transmitted infection was made in 2470 (47.3%) cases. Predominant sexually transmitted infections were herpes genitalis (964, 39%), condyloma acuminata (921, 37.9%) and syphilis (418, 17.2%). Viral sexually transmitted infections (1885, 76.3%) outnumbered bacterial sexually transmitted infections (575, 23.3%). A declining trend was noted for both bacterial and viral sexually transmitted infections over the 20 year period, which was more marked for the former. But the latter years of the study documented a rising trend in total sexually transmitted infections including bacterial sexually transmitted infections. LIMITATIONS: The study does not reflect the status of sexually transmitted infections in the general population since it was conducted in a tertiary referral center. CONCLUSION: The disturbing ascending trend recorded in sexually transmitted infections including syphilis during the final years of the 20-year period needs to be watched closely, to plan future strategies.

RegiSCAR DRESS (Drug Reaction with Eosinophilia and Systemic Symptoms) Validation Scoring System and Japanese Consensus Group Criteria for Atypical Drug-Induced Hypersensitivity Syndrome (DiHS): A Comparative Analysis.

CONTEXT: Drug reaction with eosinphilia and systemic symptoms (DRESS) and drug-induced hypersensitivity syndrome (DiHS) represent the same spectrum of a drug reaction. AIMS: To compare the clinical profile of patients diagnosed as definite/probable DRESS by the Registry of Severe Cutaneous Adverse Reaction (RegiSCAR) scoring system and as atypical DiHS by Japanese consensus group criteria. SETTINGS AND DESIGN: We did a retrospective study in a tertiary referral center. MATERIALS AND METHODS: We included patients who satisfied the criteria for definite/probable DRESS and/or atypical DiHS and who received inpatient care in our department from January 2011 to December 2018. We compared the clinical and laboratory findings in patients diagnosed by the two criteria. STATISTICAL ANALYSIS: Pearson Chi-square test was used to compare the proportion of patients with severe reactions diagnosed by the RegiSCAR DRESS validation scoring system and the Japanese consensus group criteria. RESULTS: Among the 390 case records reviewed, 138 patients could be classified as definite/probable DRESS and/or atypical DiHS. Japanese criteria did not diagnose atypical DiHS in 88/137 (64.2%) patients with definite/probable DRESS. RegiSCAR scoring system made a diagnosis of definite/probable DRESS in 49/50 (98%) patients with atypical DiHS. A total of 58/138 (42%) patients had a severe reaction. RegiSCAR scoring system diagnosed 57/58 (98.3%) patients with severe reaction as definite/probable DRESS. A total of 32/58 (55.2%) patients with severe reactions were diagnosed as atypical DiHS. The difference was statistically significant (<0.001). CONCLUSION: Japanese criteria for atypical DiHS showed reduced sensitivity to diagnose definite/probable DRESS, and this included more than 40% of patients with severe DRESS.

High-resolution ultrasound in the assessment of peripheral nerves in leprosy: A comparative cross-sectional study.

BACKGROUND: Detection of peripheral nerve thickening and nerve function impairment is crucial in the diagnosis and the management of leprosy. AIMS AND OBJECTIVES: (1) To document the cross-sectional area, echotexture and blood flow of peripheral nerves in healthy controls and leprosy cases using high-resolution ultrasound, (2) to compare the sensitivities of clinical examination and high-resolution ultrasound in detecting peripheral nerve thickening in leprosy. METHODS: Peripheral nerves of 30 leprosy patients and 30 age- and sex-matched controls were evaluated clinically and by high-resolution ultrasound. When the cross-sectional area of a peripheral nerve on high-resolution ultrasound in a leprosy patient was more than the calculated upper bound of the 95% confidence interval for mean for that specific nerve in controls, that particular peripheral nerve was considered to be enlarged. RESULTS: Cross-sectional areas more than 7.1 mm2 for the radial nerve, 8.17 mm2 for ulnar, 10.17 mm2 for median, 9.50 mm2 for lateral popliteal and 11.21mm2 for the posterior tibial nerve were considered as nerve thickening on high-resolution ultrasound. High-resolution ultrasound detected 141/300 (47%) nerves enlarged in contrast to the 60 (20%) diagnosed clinically by palpation (P < 0.001). Clinical examination identified thickening in 31/70 (44.3%) nerves in cases with impairment of nerve function and 29/230 (12.6%) in the absence of nerve function impairment. High-resolution ultrasound detected thickening in 50/70 (71.4%) nerves with impairment of function and in 91/230 (39.6%) nerves without any impairment of function. LIMITATION: A single-centre study design was the major study limitation. CONCLUSION: High-resolution ultrasound showed greater sensitivity than clinical examination in detecting peripheral nerve thickening in leprosy cases. High-resolution ultrasound, may therefore improve the sensitivity of the diagnostic criterion of peripheral nerve enlargement in the diagnosis and classification of leprosy.

Interface dermatitis as an indicator of hepatic involvement in drug reaction with eosinophilia and systemic symptoms (DRESS).

BACKGROUND: There are conflicting reports on the association between interface dermatitis and hepatic involvement in DRESS. METHODS: A cross-sectional analysis of the clinical and the histopathologic features of DRESS was performed to study the association between the histopathology of the skin rash and hepatic involvement. RESULTS: The clinical and the histopathologic findings were evaluated in 40 cases of DRESS. Thirty patients (75%) had a hepatic involvement. Thirty (75%) biopsy specimens showed a combination of different inflammatory patterns. The interface dermatitis was noted in 24 specimens (60%). Twenty-one patients with the interface dermatitis had a hepatic involvement (P = .04). CONCLUSIONS: The skin rash of DRESS often shows the coexistence of different inflammatory patterns. The interface dermatitis showed a statistically significant association with the hepatic involvement in DRESS.

A 10-year Retrospective Descriptive Study on Pure Neuritic Leprosy from a Tertiary Referral Centre.

CONTEXT: Pure neuritic leprosy is a risk factor for grade 2 disability owing to the early nerve damage. AIMS: To study the clinical patterns of neuritic leprosy, to determine the percentage of patients manifesting grade 2 disability at the time of diagnosis and to identify any risk factors for the same. SETTINGS AND DESIGN: Retrospective descriptive study from previous case records of pure neuritic leprosy patients who attended a tertiary centre from 1st July 2007 to 30th June 2017. SUBJECTS AND METHODS: Data on patients who satisfied the World Health Organization (WHO) cardinal criteria for diagnosis of leprosy, who had no skin lesion of leprosy and had acid-fast bacilli negative status on skin smears were collected using a pre-set proforma. STATISTICAL ANALYSIS USED: The Chi-square test was used to assess statistical significance and logistic regression model was applied to avoid the effects of confounding factors. RESULTS: A diagnostic delay of >1 year was observed in 44% patients. At the time of diagnosis, grade 2 disability was documented in 60 (80%) of patients. No statistically significant risk factor was identified for grade 2 disability. LIMITATIONS: Retrospective nature and the study conducted in a tertiary care centre not reflecting the status in the community were the limitations. CONCLUSIONS: Grade 2 disability noted in 80% of patients points to the inherent nature of disease to cause early nerve damage. Diagnostic delay of >1 year documented in 44% of patients underscores the diagnostic challenges in the absence of skin lesions.

Predictors of disease severity in drug reaction with eosinophilia and systemic symptoms.

BACKGROUND: Drug reaction with eosinophilia and systemic symptoms is an outcome of a complex interaction between specific drugs, certain herpesviruse types and the immune system of the affected individual and is characterized by an unpredictable course and recurrent flares even after withdrawal of the offending drug and administration of systemic steroids. AIMS: To identify the predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. METHODS: After obtaining ethical clearance from the institutional ethics committee and a written informed consent from individual study participant, the first hundred patients who required inpatient care in Government Medical College, Kozhikode with drug reaction with eosinophilia and systemic symptoms from January 1st 2011 were included in this study aimed to identify the predictors of disease severity in drug reaction with eosinophilia and systemic symptoms. RESULTS: Male-to-female ratio of the study group was 0.8:1. The presence of atypical cells in peripheral smear and advanced age were found to be predictors of disease severity in drug reaction with eosinophilia and systemic symptoms, whereas, sex, facial erythema and edema and absolute eosinophil count were found not to be predictors of the same. LIMITATIONS: The main limitation of this study was our inability to assess the role of human leukocyte antigen (HLA) association and herpes virus reactivation in disease severity in drug reaction with eosinophilia and systemic symptoms. This study was also not designed to evaluate the response to treatment given and the mortality caused by drug reaction with eosinophilia and systemic symptoms. CONCLUSIONS: Studies on the predictors of severity in drug reaction with eosinophilia and systemic symptoms in different population groups may enable us to identify the warning signs and help to formulate the standard therapeutic guidelines.