Objectives This study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalised COVID-19 adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC). Methods NCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined. Results Analysis of 29,509 hospitalised, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18752 (63.6%)] showed that 15678 (53.1%) had at least one comorbidity. Among 25715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n = 3957). Adjusted odds of dying were significantly higher in age-group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy, and tuberculosis, presenting with dyspnea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6, 7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4, 0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3, 0.7)] were protected from in-hospital mortality. Conclusions WHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality.
Mixed connective tissue disease is a distinct complex overlap disorder characterised by combination of clinical features of systemic lupus erythematosus, systemic sclerosis, polymyositis and rheumatoid arthritis. Higher levels of anti-U1-ribonucleoprotein (anti-U1RNP) antibody has been found in these patients. 39 year old female, known case of hypothyroidism, came with complaints of multiple joint pains with swelling associated with morning stiffness of fingers since last 2 years. She also had dryness of skin, loss of appetite, constipation, difficulty in swallowing and dyspnea on exertion since last 2 months. Considering the joint pains an antinuclear antibody (ANA) was sent. She turned out to be RNP, Sm, Ro 52, Mi-2 positive. Anti-CCP, rheumatoid factors (RA), Raynaud’s phenomenon all were positive. Rheumatologist opinion was taken and she was diagnosed as mixed connective tissue disorder with hypothyroidism. Patient was successfully treated with immunosuppressants and supportive measures and responded well to tablet methotrexate, prednisone, nifedipine and hydroxychloroquine. Our patient had one major and 3 minor criteria: anti RNP antibody positive, Raynaud’s phenomenon, swollen fingers and synovitis. Thus, diagnosed as mixed connective tissue disease.
BACKGROUND Haemophilia’s are X-linked hereditary blood clotting disorders due to deficiency of factor VIII (haemophilia A) or factor IX (haemophilia B) & also has identical clinical manifestations, screening tests abnormalities and sex-linked genetic transmission. Haemophilia’s result from defects in the factor VIII / IX gene that lead to decreased amount of factor VIII / IX protein, the presence of a functionally abnormal protein, or combination of both. Haemophilia A is a classic example of an X-linked recessive trait. The severity of their bleeding depends on their factor VIII activity level; and, rarely, a woman can have very low factor VIII activity, and present with symptoms of moderate or even severe haemophilia. We wanted to study the clinical profile of patients of haemophilia admitted in a tertiary care hospital. METHODS This is a cross-sectional study enrolling 60 known cases of haemophilia A & B admitted in wards & ICU / attending OPD of a tertiary care hospital. History was obtained in detail & thorough clinical examination was carried out. Precipitating factors for bleeding (spontaneous / minor trauma / major trauma / surgical operation / dental procedure / others), family h / o bleeding were studied in detail. RESULTS Of the total 60 cases of haemophilia, majority (49) of cases were of haemophilia A and 11 cases were of haemophilia B. In the study, majority (28.33 %) of cases belonged to 12 - 20 years age group and the most common presentation was haemarthrosis (61.67 %). 6 patients had factor VIII inhibitor antibodies and all of them were of haemophilia A. CONCLUSIONS Haemarthrosis is the most common clinical presentation of haemophilia and most common cause for haemarthrosis is spontaneous bleeding. Most common joint involved in bleeding was knee joint (target joint). Presence of factor VIII inhibitor antibodies specially in haemophilia A patients is not uncommon. KEYWORDS Haemophilia, Factor VIII, Factor IX
Background: Dengue fever is one of the most common arboviral mediated outbreaks reported with increased prevalence over the last few years with considerable morbidity and mortality. This study was designed to study the clinical and biochemical parameters in dengue fever patients.Methods: Prospective observational study was undertaken among adult patients in a tertiary care hospital. fifty patients were studied and analysed. All patients who were NS1 (Non-Structural Protein 1) antigen or IgM dengue positive were included in the study. Clinical features, haematological and biochemical parameters were noted.Results: Of the 50 patients studied, majority were males (68%). Fever was the major symptom (100%) followed by Body ache (84%), Headache (64%), Retro-orbital pain (52%), Myalgia (48%), conjunctival injection (40%), Itching (40%), abdominal pain (36%), Bradycardia (34%), Rash (30%), pleural effusion and ascites both seen in (28%). Significant derangements in platelet (76%), leucocyte counts (84%) and serum transaminases (58%) were noted.Conclusions: Fever associated with headache, retroorbital pain, erythematous morbilliform rash, conjunctival injection and itching over palms and soles along with thrombocytopenia, leukopenia, elevated liver transaminases should prompt a clinician on the possibility of dengue infection. Platelet transfusions have little role in management of dengue patients unless patients having active bleeding secondary to thrombocytopenia due to dengue fever.
Background: Liver cirrhosis patients are highly susceptible to bacterial infections specially Spontaneous bacterial peritonitis (SBP) which is commonest infection. this study undertaken to understand liver function tests and Spontaneous bacterial peritonitis in patients of liver cirrhosis admitted to tertiary care hospital.Methods: A descriptive cross-sectional study conducted among Liver cirrhosis patients in tertiary care center. Total 100 liver cirrhotic patients were included in present study. All the patients were subjected for biochemical evaluation of Serum albumin and globulin level, Serum bilirubin, SGOT (Serum glutamic oxaloacetic transaminase), SGPT (Serum glutamic pyruvate transaminase) and Ascitic fluid polymorph nuclear neutrophil (PMN) count to diagnose SBP.Results: Spontaneous bacterial peritonitis was present in 12% patients. Relation of Serum bilirubin level and SBP was statistically significant. Relation of serum SGOT, SGPT level and serum globulin between SBP and non-SBP group was statistically non-significant.Conclusions: Liver cirrhosis patients are susceptible for bacterial infections because of defects in various host defense mechanism and hence patients of liver cirrhosis must be screened for spontaneous bacterial peritonitis along with liver function tests.
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