Analysis of blood lead level and its clinical significance among occupational exposed painters in chennai based population: A cross sectional study.

INTRODUCTION AND AIM: Lead is a ubiquitous element found in the earth crust. There is no known physiologic role of lead in human body and hence any amount of lead present in human tissue considered as a contamination. Several studies on lead toxicity show that, occupational exposure remains the main source for lead toxicity and is emerging as important public health problem. Burden and severity of occupational exposure of lead and its clinical significance are gaining more interest in the field of toxicology. Only limited studies are available and there is scarcity of epidemiology data to assess the blood lead levels of workers and the contribution of common workplace practices to lead exposure in India especially from our region. So, the current study is designed to assess the blood lead levels (BLL) and its clinical significance among high risk workers especially painters working in the construction and public private sector in Chennai based population. MATERIALS AND METHODS: This cross-sectional case control study included 122 painters and 122 healthy individuals. A detailed questionnaire about demographic details, personal habits, work related safety precautions, presenting symptoms of lead toxicity were given to painter followed by detailed medical examination and blood investigations including blood lead levels were collected and statistically analyzed. The t-test were used to compare mean blood lead levels and to investigate the associations between specific job type, use of self-protection device,sex, service years and occurrence of non-specific symptoms with BLLs. RESULTS: The mean BLL of the painters were less than the recommended threshold level. Among painters 13.1% were categorized under BLL > 10 µg/dL. The higher BLL among the painters were directly proportional to year of experience and poor usage of personal protective materials. The levels of Hb, HCT and eosinophil were much correlated with lead toxicity. A marginal significance were observed in some parameters especially urea and creatinine when compared with control. The Cognitive dysfunction, hypertension and renal dysfunction were also observed among the painters. CONCLUSION: The BLL in painters among our group were minimal compared to biological reference value. Duration of exposure and association of patient's clinical features like cognitive dysfunction, hypertension and renal dysfunction conditions were observed and this should be carefully monitored and study on huge population of painters with longitudinal aspect is recommended to rule out the clinical correlation of lead toxicity.

Slivers of Hair - A Clue to Uncover Silver Hair Syndromes.

Silver hair syndromes (SHS) consist of rare autosomal recessive disorders, Chediak-Higashi syndrome (CHS), Griscelli syndrome (GS), and Elejalde disease. CHS is a disorder of vesicle trafficking; characterized by silvery hair, diffuse pigment dilution, immunodeficiency, bleeding diathesis, neurological manifestations, and an accelerated phase due to lymphohistiocytic infiltration. GS is characterized by hypopigmentation of skin and hair, with large clumps of pigment in the hair shaft. There are three types of GS. GS1 and GS2 show neurologic and hematologic impairments; GS3 is restricted to the skin. Some authors suggest that Elejalde syndrome is synonymous with GS Type 1. Here, we report two cases who presented with silver-gray hair but with varied clinical manifestations. With a light microscopic examination of the hair and peripheral smear, a diagnosis has been made. This report highlights the importance of hair shaft microscopy, an inexpensive, noninvasive, and simple tool in the diagnosis of SHS.

Elevated Liver Enzymes along with Comorbidity Is a High Risk Factor for COVID-19 Mortality: A South Indian Study on 1,512 Patients.

BACKGROUND AND AIMS: Liver enzyme abnormalities in coronavirus 2019 (COVID-19) are being addressed in the literature. The predictive risk of elevated liver enzymes has not been established for COVID-19 mortality. In this study, we hypothesized that elevated liver enzymes at admission can predict the outcome of COVID-19 disease with other known indicators, such as comorbidities. METHODS: This retrospective study included all the consecutive hospitalized patients with confirmed COVID-19 disease from March 4th to May 31st, 2020. The study was conducted in Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India. We assessed demography, clinical variables, COVID-19 severity, laboratory parameters, and outcome. RESULTS: We included 1,512 patients, and median age was 47 years (interquartile range: 34-60) with 36.9% being female. Liver enzyme level (aspartate aminotransferase and/or alanine aminotransferase) was elevated in 450/1,512 (29.76%) patients. Comorbidity was present in 713/1,512 (47.16%) patients. Patients with liver enzymes' elevation and presence of comorbidity were older, more frequently hospitalized in ICU and had more severe symptoms of COVID-19 at the time of admission. Presence of liver enzymes' elevation with comorbidity was a high risk factor for death (OR: 5.314, 95% CI: 2.278-12.393), as compared to patients with presence of comorbidity (OR: 4.096, 95% CI: 1.833-9.157). CONCLUSIONS: Comorbidity combined with liver enzymes' elevation at presentation independently increased the risk of death in COVID-19 by at least 5-fold.

Profile of COVID-19 Patients at Zero Delay COVID-19 Ward, Tertiary Care Hospital in South India.

INTRODUCTION: Coronavirus disease 2019 (COVID-19) pandemic is a worldwide public health crisis. During huge surge in COVID-19 cases, most of the patient arrived at Rajiv Gandhi Government General Hospital, Chennai were severe due to late presentation and also available evidence demonstrating that the delay in treatment is directly associated with increased mortality or poor patient outcome. As an innovative concept of Zero Delay COVID-19 Ward were set up to provide the required critical care for all severe COVID-19 cases. The experience of setting up of such Zero Delay COVID-19 Ward and profile of admitted COVID-19 patients were described in this paper. METHODS: A total of 4515 laboratory-confirmed COVID-19 patients admitted at Zero Delay COVID-19 Ward was analyzed retrospectively from 7th July to 31st December 2020. RESULTS: At the time of admission the frequency of dyspnea were 85.6% among them 99.1% recovered from dyspnea after the oxygen therapy and other management at Zero Delay COVID-19 Ward. Of the 4515 COVID-19 individuals, about 1829 (40.5%) had comorbidity, 227 (5%) had died. Multivariable logistic regression analysis, COVID-19 death was more likely to be associated with comorbidity (OR: 18.687; 95% CI: 11.229-31.1) than other variables. CONCLUSIONS: Comorbidity is an independent high risk factor for mortality of COVID-19 patients. From our observation, it is strongly recommended that effective zero delay covid-19 ward model will help for the prevention of mortality in current/expected waves of COVID-19.

Clinical Outcomes among Asymptomatic or Mildly Symptomatic COVID-19 Patients in an Isolation Facility in Chennai, India.

Globally, India has reported the third highest number of COVID-19 cases. Chennai, the capital of Tamil Nadu state, witnessed a huge surge in COVID-19 cases, resulting in the establishment of isolation facilities named COVID Care Center (CCC). In our study, we describe the demographic, epidemiological, and clinical characteristics; clinical progression; and outcome of 1,263 asymptomatic/mildly symptomatic COVID-19 patients isolated in one such CCC between May 4, 2020 and June 4, 2020. Around 10.5% of the patients progressed to moderate/severe illness, requiring referral for tertiary care, and three died. Nearly half (49.5%) of the patients were symptomatic at the time of admission, 2.2% of the patients developed symptoms post-testing, and 48.5% patients remained asymptomatic during the entire course of illness. Most common presenting symptoms were fever (69.9%) and cough (29.6%), followed by generalized body pain, breathlessness, and loss of smell and taste. On multivariate analysis, we identified that symptomatic patients with comorbidities and higher neutrophil-lymphocyte ratio (NLR) were more likely to progress to severe illness warranting referral for tertiary care. COVID Care Center ensured case isolation and monitoring of asymptomatic/mildly symptomatic patients, thereby providing hospital beds for sick patients. COVID Care Center isolation facilities are safe alternatives for medical institutions to isolate and monitor COVID-19 patients. Older symptomatic patients with comorbidities and a high NLR admitted in an isolation facility must be frequently monitored for prompt identification of clinical progression and referral to higher center for advanced medical care.

Association of metabolic syndrome and patatin-like phospholipase 3 - rs738409 gene variant in non-alcoholic fatty liver disease among a Chennai-based south Indian population.

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is commonly diagnosed in patients presenting with metabolic syndrome (MetS) and has been associated with single nucleotide polymorphisms of rs738409 in the patatin-like phospholipase domain containing 3 (PNPLA3) gene. This association remains to be investigated in the South Indian population. We aimed to determine the association of the PNPLA3 rs738409 gene polymorphism with MetS and NAFLD among a Chennai-based population. METHODS: The study comprised 105 NAFLD cases and 102 controls. All subjects were genotyped for the PNPLA3 rs738409 variant and MetS was defined according to the National Cholesterol Education Program - Adult Treatment Panel III criteria. Our case-control study showed the association of the variant with NAFLD and MetS. RESULTS: The PNPLA3 rs738409 variant was associated with NAFLD and the genotype frequencies (CC/CG/GG) were 19 (18.1%), 50 (47.6%) and 36 (34.3%) in the NAFLD group and 59 (57.8%), 29 (28.4%) and 14 (13.7%) in the control group respectively. We also confirmed the interaction between the PNPLA3 rs738409 polymorphism and MetS with respect tto elevated triglyceride levels. However, an association with elevated waist circumference, fasting glucose, blood pressure and decreased high-density lipoprotein cholesterol was not observed in the present study. CONCLUSIONS: The PNPLA3 rs738409 gene polymorphism increases the risk of NAFLD by up to four-fold in subjects with an elevated level of triglyceride independent of other features of MetS.