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Indian J Endocrinol Metab ; 25(1): 14-19, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34386388


Objective: COVID-19 has emerged as a multi-system disease with the potential for endocrine dysfunction. We aimed to study the hormonal profile of hospitalized patients with COVID-19 at a tertiary care referral hospital at Jodhpur, India. Design: A hospital-based clinical study of endocrine profile of COVID-19 patients conducted from 15th May to 30th June 2020 after ethical approval. Measurements: Fasting blood samples for free thyroxine (T4), free tri-iodothyronine (T3), thyroid stimulating Hormone (TSH), serum prolactin; basal and 1 h post-intramuscular adrenocorticotropic hormone (ACTH) stimulated cortisol, interleukin-6 (IL-6), and high sensitivity C-reactive protein (hsCRP) were collected within 24 h of admission after written informed consent. All hormones and IL-6 were analyzed by chemiluminescent immunoassay. hsCRP was measured by immune-turbidimetric assay. Results: Of 235 patients studied, 14% had severe disease and 5.5% died. Adrenal insufficiency was present in 14%, most of whom had mild disease. A robust adrenal response was observed in those with severe disease. Basal and post-ACTH serum cortisol were significantly increased in severe disease or those who died compared to those who were mild or asymptomatic. Basal and post-ACTH serum cortisol showed a significant positive correlation with hsCRP but not with IL-6. Low T3 and low T4 syndrome were documented in 25% and 5%, respectively. Serum TSH and FT3 levels declined significantly from asymptomatic to severe category. Hyperprolactinemia was found in 21 patients. hsCRP showed a rising trend with disease severity while IL-6 did not. Conclusions: Endocrine dysfunction in the form of adrenal insufficiency, low T3, and low TSH syndrome and hyperprolactinemia were common COVID-19 hospitalized patients.

J Family Med Prim Care ; 9(5): 2573-2576, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32754550


An iatrogenic injection abscess is usually easy to treat if caused by aerobic bacteria but some rapidly growing mycobacteria (RGM), namely, Mycobacterium fortuitum, M. chelonae, and M. abscessus are associated with postinjection abscess and may cause delayed wound healing. RGM can cause mild localized cellulitis or abscess to osteomyelitis following penetration injuries or unsafe injection practices. A 7-year-old girl was presented to pediatric surgery OPD with abscess formation over the right buttock. Incision and drainage from abscess were performed in OPD and pus sample was sent for aerobic bacterial culture and sensitivity. On gram stain plenty of pus cells with no microorganism were seen and growth on blood agar after 48 h of aerobic incubation at 37°C showed small off-white pinpoint, smooth butyrous waxy colonies. Smear prepared from blood agar showed uniformly stained short, slender, faintly stained gram-positive bacilli, for which acid-fast staining (1% and 20% H2SO4) was performed that showed acid-fast bacilli. The isolate was further identified by the molecular method and was confirmed to be Mycobacterium fortuitum by genotype Mycobacterium CM VER 1.0 (HAIN LIFESCIENCE, BioMerieux India Pvt. Ltd.).

J Family Med Prim Care ; 9(3): 1407-1412, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32509624


Respiratory tract infections are the most common diseases that are associated with social burden for the patient. Western Rajasthan has cases of Cystic fibrosis due to migrant population. The dry and dusty environment has led to prevalence of silicosis and COPD. As per IDSA (2018) guidelines, patients attending Out-Patient Department do not need microbiological investigations for lower respiratory tract infections (LRTI) except for influenza and tuberculosis. Aims: This study was conducted to identify the bacterial aetiology of LRTI among patients who attended AIIMS, Jodhpur, and to ascertain the current scenario of bacterial susceptibility in respiratory tract infections in order to optimize empiric therapy in Hospitals ad community. Methods and Material: In total, 1,775 lower respiratory tract samples were received in Bacteriology Section of Microbiology Department (January 2017 to December 2018). Bartlett's criteria were stringently used to assess quality of specimen. Semiquantitative cultures were done for tracheal aspirate and bronchoalveolar lavage samples. Following culture, the isolated organisms were identified and antimicrobial sensitivity was performed according to CLSI. Results: Total 769 bacterial pathogens were isolated from 1,775 samples collected from cases of VAP, HAP, CAP, COPD, and cystic fibrosis. Pseudomonas species was the commonest isolate (31%), followed by Klebsiella pneumonia (21.3%), Acinetobacter species (17.5%), Escherichia coli (15.4%), and Staphylococcus aureus (5%). Others include Group A ß-hemolytic Streptococcus, Burkholderia cepacia complex, Stenotrophomonas maltophilia, and Nocardia. Gram-negative organisms showed increased resistance to routinely used antibiotics. Gram-positive organisms showed 100% susceptibility to vancomycin, linezolid, and clindamycin. Conclusions: Cotrimoxazole, ßL-ßLIs, aminoglycosides, and all second-line antibiotics tested were effective for treatment of RTIs.