BackgroundAt the peak of the coronavirus disease 2019 (COVID-19) pandemic, the need for an orally administered agent to prevent the progression of acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection became increasingly evident, which was the impetus behind our investigations with molnupiravir. Molnupiravir has been shown to be effective in preventing hospitalizations and/or clinical complications in patients with mild-to-moderate COVID-19. In this study, we evaluate the efficacy and safety of molnupiravir in Indian patients with mild SARS-CoV-2 infection and at least one risk factor for disease progression (CTRI/2021/05/033739). MethodologyThis was a phase III, multicenter, randomized, open-label, controlled study conducted in Indian adults aged 18-60 years with mild SARS-CoV-2, reverse transcription polymerase chain reaction (RT-PCR)-positive within 48 hours of enrollment in the study, and within five days of first symptom onset. Enrolled patients were randomized to treatment arms in a 1:1 ratio to receive molnupiravir or placebo in addition to the standard of care (SoC) for SARS-CoV-2 infection. The SoC was in compliance with Government of India guidelines that were in force at the time. The primary endpoint was the rate of hospitalization up to day 14. Safety endpoints included incidence of adverse events (AEs). ResultsEligible patients were randomized in a 1:1 ratio to receive molnupiravir in addition to SoC treatment (n = 608) or SoC alone (n = 610). In the molnupiravir group, nine (1.48%) patients required hospitalization versus 26 (4.26%) patients in the control group (risk difference = -2.78%; 95% CI = -4.65, -0.90; p = 0.0053). Overall, 45 (3.70%) patients reported 47 AEs during the study, most of which were mild and resolved completely. The molnupiravir group reported 30 AEs compared to 17 AEs in the control group. Headache and nausea were the two most commonly reported AEs. ConclusionsThe molnupiravir arm showed a lower rate of hospitalization and a shorter time for the improvement of clinical symptoms coupled with early RT-PCR negativity. Molnupiravir was well tolerated, and AEs were mild and rare. The addition of molnupiravir to standard therapy has the potential to prevent the progression of mild COVID-19 disease to the severe form.

Background Co-occurrence of Type II Abernethy malformation (AM) with Type 1 pulmonary hypertension (PH) is extremely rare. In these patients, management of AM leads to reversal of PH. Case presentation We report a case of 24-year-old male that presented with fever and dyspnea of insidious-onset. Initial X-ray chest revealed pulmonary edema, prominent pulmonary knuckle, and dilated right descending pulmonary artery. Two-dimensional echocardiography suggested raised pulmonary artery systolic pressure (145 mmHg) and pulmonary angiogram revealed findings suggestive of Type 1 PH. Treatment with Tab. Tadalafil-Bosentan (20/5 mg, thrice daily) was initiated, but no major relief was obtained. On day 10, dyspnea worsened. Routine ultrasound revealed splenomegaly. Further evaluation with Doppler of the portal vein was suggestive of portal hypertension, and arterial ammonia was found to be raised. Contrast-enhanced computed tomography of abdomen and pelvis demonstrated a single dilated (1.3 cm) and torturous venous shunt between right internal iliac vein and superior mesenteric vein. Thus, a definitive diagnosis of Type II AM was reached. The patient was stabilized and subjected to the shunt closure with ASD Cocoon stent graft and recovered well. Conclusion Our case demonstrates a rare but reversible cause of PH. Type II AM should be included in the differential diagnosis of a patient presenting with dyspnea and provisionally diagnosed as a case of PH.

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Diabetic myonecrosis, one of the complications of chronic, inadequately controlled diabetes mellitus is seen more commonly in lower extremities and in females. We report a case of diabetic myonecrosis in upper extremities, an underreported complication of diabetes in a male from a tertiary care hospital in Mumbai. Diabetic myonecrosis usually responds to conservative management, but the long-term prognosis of the condition is poor. Identification and correct diagnosis of diabetic myonecrosis is important to avoid wrong treatment which could result in unnecessary complications.

Malaria can cause severe complications, sometimes affecting central nervous system. Cranial nerve palsies are rare after malaria. Plasmodium vivax malaria, often thought to be a benign disease can sometime lead to severe complications. We report a case of lower motor neuron palsy after plasmodium vivax malaria. KEYWORDSFacial Palsy, Vivax Malaria. HOW TO CITE THIS ARTICLE: INTRODUCTIONMalaria is a common health problem in tropical countries like India. Of the four plasmodium species causing malaria in humans, P. vivax is the most widespread. P. vivax malaria in India is more prevalent than plasmodium falciparum. 1 In India P. vivax and P. falciparum accounts for about 60-65% and 35% cases respectively. 2 P. vivax is often thought to be benign infection; however, it may sometime result in severe complications affecting different organs. 3 Commonly reported severe complications of P. vivax malaria include haematological problems, such as anaemia and thrombocytopenia, liver or kidney dysfunction, lung related complications, hypoglycaemia, shock and cerebral malaria. 2,3 We report here an unusual case of bilateral lower motor neuron palsy after P. vivax malaria.

BACKGROUNDAims and Objectives-To study serum total calcium as well as ionic calcium levels in patients with essential hypertension and to correlate serum total calcium levels and ionic calcium levels with other cardiovascular risk factors like BMI and Lipid profile, etc. MATERIALS AND METHODSIt is a descriptive study with 100 newly detected patients of essential hypertension cases and 50 age and sex matched normotensive healthy volunteers as controls. Serum calcium ionic as well as non-ionic was estimated in all the cases and controls along with other parameters. Comparisons were made using student 't' test and chi-square for univariate analysis and multivariate analysis done finally. RESULTSThere was no significant difference between mean level of serum total and ionic calcium in cases and controls in the present study. But study suggested young hypertensives had significantly lower levels of serum total calcium as compared to controls. Also elderly hypertensives had significantly higher levels of serum total calcium as well as ionic calcium compared to young hypertensives. Also, present study suggests that male hypertensives had significantly lower levels of serum total calcium as compared to controls, while female hypertensives had significantly higher levels of serum total calcium as well as ionic calcium compared to male hypertensives. A study showed serum total calcium has significant linear correlation with cardiovascular risk factors like high BMI, high levels of total cholesterol, Triglycerides and low HDL; however, ionic calcium does not have any significant correlation with BMI and lipid profile. CONCLUSIONOur study concludes that though serum calcium total as well as ionic is not associated with hypertension, but regardless of this strong linear correlation of serum total calcium with BMI and hyperlipidaemia may suggest it to be a component of metabolic syndrome.

Graves' ophthalmopathy in a hypothyroid patient without treatment for hyperthyroidism is called hypothyroid Graves' ophthalmopathy. We report a case of Graves' ophthalmopathy presenting with overt hypothyroidism who was not treated for hyperthyroidism previously.

Paraganglioma is an extra-adrenal tumour of the autonomic nervous system. Definitive diagnosis of paraganglioma is usually done with histologic examination. Surgical removal is the treatment of choice for symptomatic paraganglioma. We report a case of functional retroperitoneal paraganglioma in a 35-year-old patient who presented with symptoms of intermittent headache, palpitation and sweating.