Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are immune-mediated life-threatening skin diseases. The condition is known to be caused by various infections, drugs (mainly antibiotics), or can be idiopathic. Amidst the novel coronavirus 2019 (COVID-19) pandemic, there is an increasing number of SJS/TEN cases being reported. Viral infections are known to have decreased the threshold of drug reactions by inducing a pro-inflammatory state in the body. We report a case of TEN secondary to tamsulosin use in the setting of COVID-19 infection. There is only one documented case of tamsulosin-induced SJS, and no documented case of TEN secondary to tamsulosin use. Our patient was a 26-year-old male who presented to the hospital after a recent history of COVID-19 infection with a diffuse maculo-vesicular rash with bullae, involving the mucosa. The patient had recent use of tamsulosin on the day of presentation and there were bullae and erythematous rashes present in the oral mucosa as well as significant conjunctival erythema with pain on ocular movement on physical examination. His rash progressively worsened, involving greater than 30% of his body. A biopsy was done that showed full-thickness necrosis indicative of toxic epidermal necrolysis (TEN). We hypothesize that in our patient COVID-19 infections lowered the threshold for the development of SJS/TEN.
Objectives:To describe the sociodemographic characteristics and clinical profile of women presenting with cervical carcinoma and to identify factors associated with the timing of presentation and prognosis.Materials and Methods:A record-based descriptive study was carried out from 1st February to 31st March 2014 at Tertiary Care Hospitals of Mangalore. The study population included women who were diagnosed with cervical carcinoma from January 1, 2010 to December 31, 2013. A pretested data extraction sheet aimed at collecting information from the inpatient records was used as the study instrument. The collected data were entered and analyzed using SPSS version 16.0.Results:A total of 227 patients were included in the study. Mean (Standard Deviation) age of diagnosis of cervical cancer was found to be 55 ± 11 years. Majority of the women were Hindus (88.5%) and 51.0% of the women had occupational activities out of which manual labor was the most common. Forty-eight percent of the patients presented in the late stages. Squamous cell carcinoma was found to be the most common histological type. It was also observed that a slightly higher proportion of women with an age >49 years presented in late stages of the disease (n = 70, 48.6%) compared to women <49 years of age (n = 28, 46.7%); however, the difference was not statistically significant (P = 0.800).Conclusions:Our study found out a higher proportion of late presentation by the patients. It emphasizes the need for the development and implementation of an efficient screening cum prevention program for cervical cancer and to continue active research in the domains of identifying all possible risk factors and steps to mitigate them.
Background HIV/AIDS has a greater impact on children. Besides being orphaned by the untimely demise of one or both parents due to the disease, these children are more prone for discrimination by the society. Methods In this cross-sectional study 86 children orphaned by AIDS residing in care giving institutions for HIV positive children in Mangalore were assessed for their clinico-epidemiological profile and nutritional status. Institutional Ethics Committee clearance was obtained before the commencement of the study. The collected data were analyzed using SPSS (Statistical Package for Social Sciences) version 11.5 and the results expressed in mean (standard deviation) and proportions. BMI was calculated and nutritional status assessed using WHO Z scores (BMI for Age) for children between 5 and 19 years separately for boys and girls. Results The mean age of the children was 13.2 ± 3 years. Majority (n = 56, 65.1%) of the children were double orphans. Most of the children orphaned by AIDS (n = 78, 90.7%) had a history of both the parents being HIV positive. The median CD4 count of participants at the time of our study was 853.5 (IQR 552–1092) cells/microliter. A higher percentage of orphans were malnourished compared to nonorphans. (41.1% vs. 36.7%). All the educational institutions, wherein the children orphaned by AIDS were enrolled, were aware about their HIV status. Five of the participants felt discriminated in their schools. Only two of the participants felt discriminated by their friends because of their HIV status. Conclusion From our study we draw conclusion that even though the children orphaned due to AIDS are rehabilitated in terms of having shelter and provision of education and health care, much needs to be done in terms of improving the nutritional status of these children and alleviating the discriminatory attitude of the society towards them.
Since December 2019, the COVID-19 pandemic has caused widespread mortality and adverse economic impact throughout the world. Though predominantly a respiratory disease, concerns regarding cardiovascular effects have been highlighted. Cardiac biomarkers and their elevations in COVID-19 have been associated with higher cardiovascular disease burden and worse prognosis. The mechanism of cardiac enzyme elevation in COVID-19 can be explained under two broad categories- direct injury caused by downregulation of ACE2 and hypoxemia, and indirect injury, which is mediated by the cytokine storm. Cardiac troponin and high sensitivity troponin are the most extensively studied cardiac enzymes in COVID-19. Studies have shown comparable and in some cases better predictive value than traditional markers of inflammation like d-dimer, C-reactive protein, lactate dehydrogenase. Natriuretic peptides such as BNP have utility as a robust prognostic marker in COVID-19 when considering outcomes like the need for mechanical ventilation and mortality. Emerging data from studies investigating the role of newer cardiac biomarkers in COVID-19 like mid-regional proadrenomedullin, growth differentiation factor-15 have also yielded promising results. As advances are made in our understanding of the pathogenesis, diagnosis, and management of COVID-19, it is evident that investigating the role of cardiac biomarkers in COVID-19 provides vital information.
INTRODUCTION:Excessive dynamic airway collapse (EDAC) and Obstructive Sleep Apnea (OSA) are two entities which could cause significant negative intrathoracic pressure with resulting pulmonary edema. We present a case of obese patient with Down syndrome, severe OSA and EDAC who developed noncardiogenic pulmonary edema. CASE PRESENTATION:A 22-year-old male with a past medical history of Down syndrome, morbid obesity (BMI 44) and severe OSA not on CPAP, was admitted for shortness of breath and an episode of emesis. He was reportedly sleeping at home when suddenly started vomiting and developed severe shortness of breath. On exam, bilateral wheezing and a dry cough were present. He was hemodynamically stable, afebrile, hypoxic with saturation to 80%, requiring supplemental oxygen through a high flow delivery circuit. Labs were significant for WBC 16.1, a negative COVID-19 test, a negative procalcitonin, normal lactate and normal BNP, blood culture negative. Chest X-ray (CXR) showed bilateral pulmonary congestion, and CT of the chest confirmed bilateral diffuse pulmonary edema and showed dynamic tracheal collapse. The patient was aggressively diuresed and was quickly weaned off of supplemental oxygen with aggressive diuresis and was discharged home with recommendations to follow up with his primary pulmonologist for further investigation into the high suspicion for EDAC and for evaluation for CPAP therapy.DISCUSSION: EDAC occurs when there is a greater than 50% reduction of the sagittal diameter of the trachea in forced expiration or while coughing that results in an excessive collapse of the posterior membranous trachea towards the lumen without a collapse of cartilage. EDAC may present with coughing, difficulty clearing secretions, dyspnea, and stridor and often is mislabeled as COPD, asthma, or laryngeal edema. The diagnosis of EDAC can be made through dynamic bronchoscopy or dynamic radiologic imaging, like dynamic CT. An association between OSA and EDAC is theorized to exist, as repeated tension during inspiration against an occluded glottis during sleep may promote the development of EDAC. Moreover, an elevation in dynamic intra-thoracic central airway collapse may be associated with increasingly severe OSA, measured by obstructive respiratory events and degree of hypoxia. Ultimately, pulmonary edema may develop due to the effects of severe hypoxemia and/or extreme negative intrathoracic pressure which may result from severe OSA, with the possibility of EDAC playing a role in certain patient populations.CONCLUSIONS: EDAC is an underrecognized entity that may result in mild symptoms including cough and wheezing, to outright pulmonary edema and respiratory failure. OSA is theorized to be associated with EDAC, but additional research is needed to provide more definitive evidence of the relationship between the two conditions.
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