Is Hyperuricemia a Marker of Severity of Disease in Scrub Typhus?

AIMS: To study association of hyperuricemia with severity of scrub typhus. METHODS: We studied clinical features, laboratory profile, in hospital course and outcome of 92 patients of scrub typhus and association of hyperuricemia with severity of disease. RESULTS: Of total 92 patients in study group, 66 (71.7%) were females and 26(28.3%) were males. Fever (100%), cough (37%), headache (33%), vomiting (31%), altered sensorium (23%), diarrhea (18%), abdominal pain (16%), myalgia (14%), and seizures (3%) were common clinical features. Eschar was present in 23%. Of total 92 patients 34 (37%) patients had hyperuricemia (HU) and 58 patients had normal serum uric acid levels. The patients of scrub typhus with HU had significantly higher presentation with altered sensorium (35.3%). In HU group, mean TLC, mean serum urea and serum creatinine were higher and mean serum albumin and mean HDL cholesterol were lower than patients of scrub typhus without hyperuricemia. These differences between two groups were statistically significant. Neurological dysfunction, severe sepsis, serum creatinine >3.5mg/dL and involvement of at least single organ was significantly higher in HU group. Total 4 patients (4.3%) died and all had HU. CONCLUSION: Hyperuricemia in patients of scrub typhus was associated with severe scrub typhus. The serum uric acid levels should be done in early course of all patients suffering from scrub typhus. The patients showing hyperuricemia should be monitored closely for early recognition of complications and management aggressively.

Obstructive sleep apnea and coronary artery disease: An unholy nexus or a holy alliance?

Coronary artery disease (CAD) is a significant cause of morbidity and mortality globally, and hypertension, dyslipidemia, diabetes mellitus, and smoking are major cardiovascular (CV) risk factors. Obstructive sleep apnea (OSA) and CAD share an exciting relationship, and recently, OSA has emerged as a non-traditional CV risk factor. OSA is characterized by episodic sleep state-dependent collapse of the upper airway, resulting in periodic reductions or cessations in ventilation, with consequent hypoxia, hypercapnia, or arousals from sleep. The oxidative stress and vascular inflammation resulting from the nocturnal hypoxia followed by reoxygenation cycles predispose the patients to the development of atherosclerotic cardiovascular disease (CVD). Untreated OSA is associated with long-term health consequences, including CVD, metabolic disorders, cognitive impairment, and depression. Paradoxically, some recent studies have reported that patients with OSA may suffer less severe CAD due to the development of collateral circulation due to repetitive hypoxia experienced due to OSA.

Prevalence of obstructive sleep apnoea among patients admitted with acute coronary syndrome in a hill state of northern India.

Background Obstructive sleep apnoea (OSA) is one of the emerging non-traditional cardiovascular risk factors. Studying OSA may contribute towards a better understanding of current concepts of atherogenesis and in guiding therapy. Methods We conducted this cross-sectional study among 66 patients with acute coronary syndrome (ACS) in a tertiary care hospital from 1 January 2019 to 30 June 2020. We included patients of ST elevation myocardial infarction (STEMI)/ non-STEMI (on achieving Killip class I/II) and unstable angina and performed in-hospital overnight polysomnography (PSG) within 8 weeks of index event. Apnoea-hypoapnoea index (AHI) value 5-<15 was defined as mild OSA, AHI 15-<30 as moderate OSA and AHI >30 as severe OSA. We analysed data using Epi Info version 7.2.4 for Windows. Results The 66 patients had a mean (SD) age of 57.7 (11.1) years and 54 (81.8%) were men. Forty-three (65.1%) patients had STEMI, 19 (28.7%) had non-STEMI and 4 (6%) had unstable angina. On PSG, the prevalence of OSA (AHI>5) was 78.8% (95% CI 67.0-87.9). Of these, AHI >15 was significantly associated with diabetes, hypertension and different measures of obesity (p<0.05). Conclusions This study, conducted in a hill state of northern India, showed a high prevalence of OSA in patients with ACS. Obesity, diabetes mellitus and hypertension were significantly associated with severity of OSA (AHI>15).

Neuropsychiatric Manifestations of Scrub Typhus.

Scrub typhus is caused by Orientia tsutsugamushi characterized by focal or disseminated vasculitis and perivasculitis which may involve the lungs, heart, liver, spleen and central nervous system. It was thought to have been eradicated from India. Recently it is being reported from many areas of India. The clinical picture and severity of the symptoms varies widely. The neurological manifestations of scrub typhus are not uncommon but are diverse. Meningoencephalitis is classical manifestation of scrub typhus but cerebellitis, cranial nerve palsies, plexopathy, transverse myelitis, neuroleptic malignant syndrome and Guillan-Barré syndrome are other manifestations reported in literature. The availability of literature on the neurological manifestations of scrub typhus is limited to case reports mainly. This article reviews various neurological manifestations of scrub typhus reported in literature.