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Background: Severe acute respiratory syndrome coronavirus 2 (SARS CoV2) has caused the global pandemic, COVID-19. Though predominantly a respiratory illness, cardiac manifestations of COVID-19 significantly contribute to mortality. We wanted to determine whether admission electrocardiographic (ECG) characteristics provide prognostic information in COVID-19.Methods: We performed a retrospective, cross-sectional observational study in a designated District COVID hospital. COVID-19 patient’s medical records were converted into an electronic database which included demographic data, clinical characteristics and electrocardiogram recorded at/near the time of admission. Primary outcome assessed was the occurrence of severe COVID-19.Results: Of 180 patients, the majority were males (67.8%) and aged 31-50 years (38.9%). The predominant comorbidity among patients who were discharged (non-severe COVID-19 disease) and those who got referred (severe COVID-19 disease) was hypertension (56.5% vs 43.3%), followed by diabetes mellitus (37.7% vs 36.7%). Fatigue (41.9%) and cough (18.5%) were the most frequent symptoms among non-severe cases. Of 32.8% of the patients with abnormal ECG, abnormal axis (25.5%), poor R wave progression (23.5%), T inversion (15.3%), left ventricular hypertrophy (12.2%) followed by ST segment depression (8.3%) were the frequent findings. Logistic regression analysis revealed that elderly patients (>60 years) (β=2.276, OR=9.737, p=0.002), Heart rate (β=0.191, OR=1.211, p=0.045) and ST segment depression (β=9.986, OR=21725.39, p=0.022) showed statistically significant positive association with Severe COVID-19.Conclusions: ST segment abnormalities on admission ECG are markers of cardiac injury and may assist in prognostication of COVID-19. Early identification of these findings might play a crucial role in identifying patients likely to progress to severe COVID-19.

BACKGROUND Malnourishment is a major public health challenge in India. The prevalence of thyroid disorders is about 15 – 25 % in different parts of the country. As Thyroid hormone is essential for normal erythropoiesis, anaemia often accompanies thyroid disorders. It is also observed that iron deficiency anaemia state negatively influences the thyroid hormone function. So, the relationship between anaemia and thyroid disorders is complex and both have to be addressed. Keeping this in view, we tried to study the haematological parameters of inpatients with thyroid disorders in our hospital. METHODS A retrospective hospital based observational study was conducted in Gayatri Vidya Parishad Institute of Healthcare and Medical Technology, Visakhapatnam. All adults (> 18 yrs. of age), non-pregnant patients admitted during the period November 2017 to November 2018 with a diagnosis of thyroid disorder at discharge were included in the study. Fasting thyroid profile (using Siemens advanced fully automated analyser) and haematological parameters (using automated haematology analyser - LABLIFE NOBLE III) were obtained. Data analysis was done using Microsoft Excel 2013 and SPSS version 26. RESULTS 107 patients were included in the study. Mean age of the patients was 33.20 (± 12.45) years with majority being female (91.6 %) and of the age group 18 – 40 years (80.3 %). Hypothyroidism (73.83 %) was the most common thyroid disorder observed followed by subclinical hypothyroidism (19.63 %) & hyperthyroidism (6.54 %). About 79.6 % of female patients and all male patients had anaemia of varying degree. Majority of the patients had moderate degree of anaemia [haemoglobin of 8 - 11.9 gm / dL (females) / 8 - 12.9 gm / dL (males)]. Both microcytic hypochromic anaemia (53.8 %) and normocytic normochromic anaemia (46.2 %) were almost equally prevalent in female patients. Statistically significant positive correlation was observed between TSH (Thyroid Stimulating Hormone) and mean corpuscular volume. (Pearson’s correlation = 0.324, significant correlation at the level 0.01.). CONCLUSIONS Our study highlighted the association between anaemia and thyroid dysfunction. As anaemia is common in our country and the occurrence of hypothyroidism and other thyroid disorders is on the rise, it is essential for clinicians to understand the interrelation between both the disorders and make appropriate therapeutic decisions for simultaneous treatment of anaemia as well as thyroid dysfunction as one may be the cause of the other. KEYWORDS Anaemia, Thyroid Dysfunction, Hypothyroidism

BACKGROUND End stage renal disease (ESRD) is the irreversible deterioration of renal function which results from impairment of excretory, metabolic, endocrine functions leading to the development of the clinical syndrome of uraemia. Chronic Kidney disease (CKD) is recognised worldwide as a public health problem. In India, prevalence of CKD is high, and as per data available from various studies, approximate prevalence of CKD is around 800/million population. 2-4 Diminished estimated glomerular filtration rate (eGFR) is a powerful, graded, independent predictor of cardiovascular morbidity and mortality 5 and all-cause mortality. METHODS Patients with chronic kidney disease with End Stage Renal Disease admitted in King George Hospital, Visakhapatnam during the period from November 2018 to March 2019 were included in the study. This is a retrospective observational study. RESULTS A total of fifty CKD patients with ESRD were studied to determine the range of abnormalities of cardiac function. The predominant gender in the study group was male, constituting 68%. Hypertension was the most common aetiology of CKD with 21 (42%) patients, followed by hypertension & diabetes together (22%) and diabetes mellitus alone (20%). Other causes were NSAID abuse (6%), IgA Nephropathy (2%), Polycystic Kidney Disease (2%) & unknown aetiology (6%). Cardiovascular abnormalities were observed in large number of patients with ESRD (76%). LVH was the most common echocardiographic abnormality in CKD cases. Diastolic function was deranged more when compared to systolic function in patients with CKD. CONCLUSIONS High prevalence of left ventricular hypertrophy, diastolic dysfunction on echocardiography implies that these patients require detailed cardiovascular evaluation despite the absence of symptoms. Early detection of cardiac abnormalities by echocardiography before the development of overt cardiac symptoms might contribute to better prognosis in these patients.

Background: Hypertensive emergency is defined by systolic blood pressure (SBP) ≥180 mmHg and/or diastolic blood pressure (DBP) ≥120 mmHg with acute target organ damage. Hypertensive emergencies can be life threatening and fatal unless timely treated. In the present study we aim to study the clinical profile and outcome of patients admitted with hypertensive emergency in the medical intensive care unit in our hospital. Methods: A cross-sectional observational study of all cases with hypertensive emergency admitted in Medical Intensive care unit (ICU) in Government General Hospital, Srikakulam during the study period was conducted. The clinical profile and outcome of the patients were assessed. Results: Out of the fifty patients in the present study, about 36 (72%) were males and 14 were females (28%) and about one third of the patients (36%) belonged to the age group of 60-69 years. Diabetes mellitus (30%) and dyslipidemia (40%) were the commonly encountered comorbidities in the study population. Most frequent presenting symptoms were neurological deficits (50%) followed by dyspnoea (32%) and chest pain (24%). Intracerebral haemorrhage was the commonest target organ damage found in 30% of the patients. Patients presenting with hypertensive emergencies with neurological target organ damage had statistically significant increased chance of mortality (p=0.007). Conclusions: As hypertension emergencies are consequence of uncontrolled hypertension, it is important to educate and bring awareness among public regarding the screening, early detection, and adherence to prescribed medication for hypertension to avoid adverse clinical outcomes.