Introduction This research aimed to assess the nutritional intake and anthropometry of patients presenting with CKD in a hospital clinic. Methods The study was carried out on 100 CKD patients who were on maintenance hemodialysis at Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India. The patient’s file was inspected to get the relevant anthropometric and biochemical data. The information was gathered using a pre-designed proforma. Results The study included 100 CKD patients with a mean age of 45.74 ± 14.93 years. Males outnumber females, with a male-to-female ratio of 6.69:1. The mean calorie and protein given to the CKD patients (according to body weight) are 1657.60 ± 240.179 and 71.75 ± 77.165, respectively. The mean weight, BMI, and MUAC of the CKD patient were 57.371±6.22, 21.56 ± 1.705, and 23.86 ± 1.709, respectively. After 3 months of nutritional assessment, the patient’s mean weight, BMI, and MUAC were increased. The mean cholesterol, Triglyceride, HDL, VLDL, and RBS levels of the CKD patient were 163.90 ± 29.75, 139.76 ± 35.72, 49.46 ± 6.29, 28.488 ± 7.114, and 117.65 ± 21.46, respectively. After three months of the nutritional assessment, the patient’s mean cholesterol, Triglyceride, HDL, and VLDL levels increased while RBS level decreased. The CKD patient’s mean S. creatinine and S. albumin levels were 9.97 ± 3.453 and 3.285 ± 0.531, respectively. After 3 months of nutritional assessment, the patient’s mean S. creatinine and S. albumin levels increased to 10.4231 ± 3.420 and 4.056 ± 5.6389, respectively. Conclusion The nutritional diet influences body weight, BMI, and biochemical indicators. Low energy and protein intake was reported; hence, educating patients, co-patients, and families about the essential foods that fulfill the recommended intake for CKD patients is required. Follow-up patients showed better nutritional knowledge as compared with baseline patients.
{"title":"Nutritional Assessment in Chronic Kidney Disease Patients in the Bundelkhand Region (Uttar Pradesh), India","authors":"S. Yadav, Rajeev Verma, Kanishka Kumar, Praveen Raman Mishra, Deepak Chandra Srivastavsa, Priya Budhwani","doi":"10.1177/26339447221148890","DOIUrl":"https://doi.org/10.1177/26339447221148890","url":null,"abstract":"Introduction This research aimed to assess the nutritional intake and anthropometry of patients presenting with CKD in a hospital clinic. Methods The study was carried out on 100 CKD patients who were on maintenance hemodialysis at Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India. The patient’s file was inspected to get the relevant anthropometric and biochemical data. The information was gathered using a pre-designed proforma. Results The study included 100 CKD patients with a mean age of 45.74 ± 14.93 years. Males outnumber females, with a male-to-female ratio of 6.69:1. The mean calorie and protein given to the CKD patients (according to body weight) are 1657.60 ± 240.179 and 71.75 ± 77.165, respectively. The mean weight, BMI, and MUAC of the CKD patient were 57.371±6.22, 21.56 ± 1.705, and 23.86 ± 1.709, respectively. After 3 months of nutritional assessment, the patient’s mean weight, BMI, and MUAC were increased. The mean cholesterol, Triglyceride, HDL, VLDL, and RBS levels of the CKD patient were 163.90 ± 29.75, 139.76 ± 35.72, 49.46 ± 6.29, 28.488 ± 7.114, and 117.65 ± 21.46, respectively. After three months of the nutritional assessment, the patient’s mean cholesterol, Triglyceride, HDL, and VLDL levels increased while RBS level decreased. The CKD patient’s mean S. creatinine and S. albumin levels were 9.97 ± 3.453 and 3.285 ± 0.531, respectively. After 3 months of nutritional assessment, the patient’s mean S. creatinine and S. albumin levels increased to 10.4231 ± 3.420 and 4.056 ± 5.6389, respectively. Conclusion The nutritional diet influences body weight, BMI, and biochemical indicators. Low energy and protein intake was reported; hence, educating patients, co-patients, and families about the essential foods that fulfill the recommended intake for CKD patients is required. Follow-up patients showed better nutritional knowledge as compared with baseline patients.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"23 1","pages":"11 - 16"},"PeriodicalIF":0.0,"publicationDate":"2023-03-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80559283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-20DOI: 10.1177/26339447221150730
L. Kannan
Acute uremic pericarditis is an indication for initiating dialysis in patients with stage V chronic kidney disease. Even in patients with end-stage renal disease (ESRD), cardiac involvement manifests itself mostly as uremic pericarditis. Chronic constrictive pericarditis, also known as dialysis pericarditis, is relatively rare. The cause of chronic constrictive pericarditis is multifactorial and, in most cases, remains uncertain. The most common symptoms are fatigue, dyspnea, and peripheral edema. We present a case of a woman with history of coronary artery bypass graft surgery a year back and on chronic dialysis who developed constrictive pericarditis. Our case illustrates the importance of this rare entity in dialysis patients as timely intervention with intensification of dialysis and pericardiectomy is needed to prevent progression to an incapacitating state.
{"title":"Chronic Constrictive Pericarditis After CABG or Hemodialysis?","authors":"L. Kannan","doi":"10.1177/26339447221150730","DOIUrl":"https://doi.org/10.1177/26339447221150730","url":null,"abstract":"Acute uremic pericarditis is an indication for initiating dialysis in patients with stage V chronic kidney disease. Even in patients with end-stage renal disease (ESRD), cardiac involvement manifests itself mostly as uremic pericarditis. Chronic constrictive pericarditis, also known as dialysis pericarditis, is relatively rare. The cause of chronic constrictive pericarditis is multifactorial and, in most cases, remains uncertain. The most common symptoms are fatigue, dyspnea, and peripheral edema. We present a case of a woman with history of coronary artery bypass graft surgery a year back and on chronic dialysis who developed constrictive pericarditis. Our case illustrates the importance of this rare entity in dialysis patients as timely intervention with intensification of dialysis and pericardiectomy is needed to prevent progression to an incapacitating state.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"28 1","pages":"56 - 59"},"PeriodicalIF":0.0,"publicationDate":"2023-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89345522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-17DOI: 10.1177/26339447221149517
H. Mahapatra, P. Chaudhary, M. B., V. Gupta, Beauty Suman Singh
Mucormycosis of the renal allograft is an extremely rare and rapidly fatal infection with an incidence of 0.2−1.2%. The major predisposing risk factors are uncontrolled diabetes mellitus, immunosuppression, anti-rejection treatment, unrelated donors, and cytomegalovirus infection. We describe a case of 27-year-old young adult patient who underwent a live-related renal allograft transplant at our centre and presented 4 weeks post-transplant with high-grade fever and rapid rise in serum creatinine. Initial cultures were repeatedly sterile, and imaging studies were normal. A few days later, he developed graft tenderness, and contrast CT abdomen revealed graft pyelonephritis. He was non-responsive to broad-spectrum antibiotics, and renal function gradually declined to anuric state. Prophylactic antifungal was added and hemodialysis was initiated. A graft biopsy was done, which revealed infiltration of the graft kidney with mucor species. After a week of antifungal treatment, graft nephrectomy was done and dual antifungals were continued. The patient initially improved symptomatically but again deteriorated with new onset fever and pain abdomen. Repeat imaging revealed a moderate intra-abdominal collection managed with per-cutaneous aspiration showing sterile growth and an abdominal drain kept in situ. Four days later, there was an accidental intra-abdominal drain expulsion with oozing of pus with blood which increased acutely with a sudden drop in blood pressure and hematocrit. Emergency exploration was done, which revealed a rent in the external iliac artery. After vascular rent repair surgery, the patient initially showed gradual improvement hemodynamically, but later, he developed superadded bacterial infection at the graft nephrectomy wound site with refractory septic shock and expired. Though early diagnosis, appropriate antifungal agents, and graft nephrectomy may improve the patient outcome, the case fatality rate of renal graft mucormycosis still remains very high.
{"title":"Renal Allograft Mucormycosis: An Unusual Case Report","authors":"H. Mahapatra, P. Chaudhary, M. B., V. Gupta, Beauty Suman Singh","doi":"10.1177/26339447221149517","DOIUrl":"https://doi.org/10.1177/26339447221149517","url":null,"abstract":"Mucormycosis of the renal allograft is an extremely rare and rapidly fatal infection with an incidence of 0.2−1.2%. The major predisposing risk factors are uncontrolled diabetes mellitus, immunosuppression, anti-rejection treatment, unrelated donors, and cytomegalovirus infection. We describe a case of 27-year-old young adult patient who underwent a live-related renal allograft transplant at our centre and presented 4 weeks post-transplant with high-grade fever and rapid rise in serum creatinine. Initial cultures were repeatedly sterile, and imaging studies were normal. A few days later, he developed graft tenderness, and contrast CT abdomen revealed graft pyelonephritis. He was non-responsive to broad-spectrum antibiotics, and renal function gradually declined to anuric state. Prophylactic antifungal was added and hemodialysis was initiated. A graft biopsy was done, which revealed infiltration of the graft kidney with mucor species. After a week of antifungal treatment, graft nephrectomy was done and dual antifungals were continued. The patient initially improved symptomatically but again deteriorated with new onset fever and pain abdomen. Repeat imaging revealed a moderate intra-abdominal collection managed with per-cutaneous aspiration showing sterile growth and an abdominal drain kept in situ. Four days later, there was an accidental intra-abdominal drain expulsion with oozing of pus with blood which increased acutely with a sudden drop in blood pressure and hematocrit. Emergency exploration was done, which revealed a rent in the external iliac artery. After vascular rent repair surgery, the patient initially showed gradual improvement hemodynamically, but later, he developed superadded bacterial infection at the graft nephrectomy wound site with refractory septic shock and expired. Though early diagnosis, appropriate antifungal agents, and graft nephrectomy may improve the patient outcome, the case fatality rate of renal graft mucormycosis still remains very high.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"15 1","pages":"53 - 55"},"PeriodicalIF":0.0,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88024873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-05DOI: 10.1177/26339447231152068
Subhash Kumar, Mala Mahto
Vitamin B12 deficiency has been classically associated with subacute combined degeneration of the cord. It can be readily recognized on magnetic resonance imaging as T2W hyperintensity of the dorsal column. Cerebral changes are being increasingly notified, especially in the elderly population. The authors report the case of a 33-year-old patient and describe the imaging characteristics.
{"title":"Cerebral White Matter Demyelination in Vitamin B12 Deficiency: A Case Report","authors":"Subhash Kumar, Mala Mahto","doi":"10.1177/26339447231152068","DOIUrl":"https://doi.org/10.1177/26339447231152068","url":null,"abstract":"Vitamin B12 deficiency has been classically associated with subacute combined degeneration of the cord. It can be readily recognized on magnetic resonance imaging as T2W hyperintensity of the dorsal column. Cerebral changes are being increasingly notified, especially in the elderly population. The authors report the case of a 33-year-old patient and describe the imaging characteristics.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"13 1","pages":"39 - 42"},"PeriodicalIF":0.0,"publicationDate":"2023-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72518456","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-03-05DOI: 10.1177/26339447221145821
Camelia Porey, B. Jaiswal
Guillain-Barre syndrome (GBS) is an immune triggered inflammatory polyneuropathy precipitated by various triggers by means of cross reactivity and molecular mimicry. Tuberculosis (TB) of any organ, although may produce features of peripheral neuropathy, has rarely been associated with GBS. We describe a middle-aged female patient in whom pulmonary TB manifested with GBS primarily without any prominent constitutional symptoms and review the literature to strengthen our viewpoint in this regard. The treatment with immunomodulators is beneficial with good outcome and thus early diagnosis and intervention is suggested.
{"title":"A Precipitant Less Appreciated: A Glance at Cases of Tuberculosis Manifesting with Guillain Barre Syndrome","authors":"Camelia Porey, B. Jaiswal","doi":"10.1177/26339447221145821","DOIUrl":"https://doi.org/10.1177/26339447221145821","url":null,"abstract":"Guillain-Barre syndrome (GBS) is an immune triggered inflammatory polyneuropathy precipitated by various triggers by means of cross reactivity and molecular mimicry. Tuberculosis (TB) of any organ, although may produce features of peripheral neuropathy, has rarely been associated with GBS. We describe a middle-aged female patient in whom pulmonary TB manifested with GBS primarily without any prominent constitutional symptoms and review the literature to strengthen our viewpoint in this regard. The treatment with immunomodulators is beneficial with good outcome and thus early diagnosis and intervention is suggested.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"66 1","pages":"43 - 52"},"PeriodicalIF":0.0,"publicationDate":"2023-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72649082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-02-07DOI: 10.1177/26339447221143212
R. Vaman, S. Mathew
Foodborne diseases are a significant cause of morbidity and mortality, especially in low-resource settings. This paper describes the investigation conducted in response to a cluster of acute gastroenteritis outbreak in the Wayanad district of Kerala. House-to-house visits were undertaken to identify the case patients, along with laboratory and environmental investigations. The attack rate was 41.2% among those who consumed chicken biriyani compared to 6.9% among those who consumed vegetarian meals. The risk difference (95% CI) was 34.34 % (22.8-45.6), and the risk ratio (95% CI) was 6 (1.6-23) for chicken biriyani compared to vegetarian meals. The attributable fraction (95% CI) among those who ate chicken biriyani was 83.3% (35.6-95.6), and the population attributable fraction was 81.2%. We recommend strengthening of laboratory capacity for detecting foodborne pathogens and active surveillance of all food handlers and food preparation areas with the coordination of food safety, health and local self government departments.
{"title":"An Outbreak Investigation of a Cluster of Gastroenteritis Following a Marriage Function in Wayanad District, Kerala, India","authors":"R. Vaman, S. Mathew","doi":"10.1177/26339447221143212","DOIUrl":"https://doi.org/10.1177/26339447221143212","url":null,"abstract":"Foodborne diseases are a significant cause of morbidity and mortality, especially in low-resource settings. This paper describes the investigation conducted in response to a cluster of acute gastroenteritis outbreak in the Wayanad district of Kerala. House-to-house visits were undertaken to identify the case patients, along with laboratory and environmental investigations. The attack rate was 41.2% among those who consumed chicken biriyani compared to 6.9% among those who consumed vegetarian meals. The risk difference (95% CI) was 34.34 % (22.8-45.6), and the risk ratio (95% CI) was 6 (1.6-23) for chicken biriyani compared to vegetarian meals. The attributable fraction (95% CI) among those who ate chicken biriyani was 83.3% (35.6-95.6), and the population attributable fraction was 81.2%. We recommend strengthening of laboratory capacity for detecting foodborne pathogens and active surveillance of all food handlers and food preparation areas with the coordination of food safety, health and local self government departments.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"13 1","pages":"34 - 38"},"PeriodicalIF":0.0,"publicationDate":"2023-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81833154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-25DOI: 10.1177/26339447221142358
Sate Singh, Nitisha Mondia
Introduction Adrenal insufficiency is noted in patients of cirrhosis, mainly in critically ill patients. Cirrhosis characterized with low synthetic functions has multiple indirect markers for severity. Methodology 100 decompensated cirrhosis patients were hospitalized to Lady Hardinge Medical College in New Delhi as part of an observational cohort research from October 2014 to June 2016. Adrenocorticotrophic hormone stimulation test was done with 250 mcg, basal cortisol, and cortisol after 60 minutes of stimulation was noted. We investigated the relationship between blood HDL levels and adrenal insufficiency. Results Insufficient adrenal function was detected in 28% of the patients. INR, serum total bilirubin, serum creatinine, low high-density lipoprotein (HDL), child score, MELD score, plasma renin activity level, and renal resistive index were all associated with patients with adrenal insufficiency on univariate analysis. Multivariate analysis showed in patients with adrenal insufficiency, MELD score had odds ratio of 1.5 with AUC 0.724 (0.622-0.825), Bilirubin with odds ratio of 5.6 and AUC of 0.676 (0.679-0.882). Serum HDL with odds ratio of 6.1 (3.3-9.2) and AUC 0.822 (0.724-0.828) with P value <0.001, cut off calculated was 26 mg/dL with sensitivity of 81% and specificity of 85% predicts adrenal insufficiency. Patients with adrenal insufficiency had higher mortality. Conclusion Cirrhosis is associated with adrenal insufficiency, more with advanced liver disease. Low HDL level in blood can be taken as an indirect marker for adrenal insufficiency.
{"title":"Adrenal Insufficiency Associated with Low High-Density Lipoprotein (HDL) in Patients of Chronic Liver Disease","authors":"Sate Singh, Nitisha Mondia","doi":"10.1177/26339447221142358","DOIUrl":"https://doi.org/10.1177/26339447221142358","url":null,"abstract":"Introduction Adrenal insufficiency is noted in patients of cirrhosis, mainly in critically ill patients. Cirrhosis characterized with low synthetic functions has multiple indirect markers for severity. Methodology 100 decompensated cirrhosis patients were hospitalized to Lady Hardinge Medical College in New Delhi as part of an observational cohort research from October 2014 to June 2016. Adrenocorticotrophic hormone stimulation test was done with 250 mcg, basal cortisol, and cortisol after 60 minutes of stimulation was noted. We investigated the relationship between blood HDL levels and adrenal insufficiency. Results Insufficient adrenal function was detected in 28% of the patients. INR, serum total bilirubin, serum creatinine, low high-density lipoprotein (HDL), child score, MELD score, plasma renin activity level, and renal resistive index were all associated with patients with adrenal insufficiency on univariate analysis. Multivariate analysis showed in patients with adrenal insufficiency, MELD score had odds ratio of 1.5 with AUC 0.724 (0.622-0.825), Bilirubin with odds ratio of 5.6 and AUC of 0.676 (0.679-0.882). Serum HDL with odds ratio of 6.1 (3.3-9.2) and AUC 0.822 (0.724-0.828) with P value <0.001, cut off calculated was 26 mg/dL with sensitivity of 81% and specificity of 85% predicts adrenal insufficiency. Patients with adrenal insufficiency had higher mortality. Conclusion Cirrhosis is associated with adrenal insufficiency, more with advanced liver disease. Low HDL level in blood can be taken as an indirect marker for adrenal insufficiency.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"9 1","pages":"6 - 10"},"PeriodicalIF":0.0,"publicationDate":"2023-01-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88655497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1177/26339447221138183
Priyanka Verma, R. Sahoo, A. Ahuja, Nutan Dixit, T. Dewan, A. Mammel
Mucormycosis is a rare and ominous fungal disease caused by the order Mucorales fungi. As per Indian data, uncontrolled diabetes is the main risk factor associated with mucormycosis. But during this SARS COV-2 pandemic, a huge rise in the number of mucormycosis cases has been observed in different states in India in last 10-12 months in the second wave. The immune dysfunction caused by this virus and the use of high doses of steroids appears to be a double-edged sword and causes immunosuppression with hyperglycemia, increasing the risk of secondary bacterial and invasive fungal infections (IFIs). Objective We conducted a prospective observational study involving individuals with proven mucormycosis in ABVIMS & Dr RML Hospital, New Delhi. The demographic profile with various clinical presentations, histopathological findings, predisposing factors, management, and final outcomes were recorded. Results We included 53 patients in our study. Rhino-orbital-cerebral mucormycosis was the most common (21/53, 39.6%) presentation followed by rhino-orbital (17/53, 32.0%), rhino-cerebral (10/53, 18.8% ) rhinosinusitis (4/53, 7.5%) and pulmonary involvement in 1/53, (1.8%). The cutaneous involvement was seen in 8 patients (15.0%), disseminated mucormycosis as meningitis in 2 patients (3.7%), and dual fungal infection with aspergillosis was seen in 2 patients (3.7%). The predisposing factors being diabetes mellitus (40/53, 75.4%), with newly diagnosed diabetes in previously undiagnosed (10/ 53, 18.8%), SARS-COV-2 (33/53, 62.2%), steroid intake (30/53, 56.6% ), prolonged hospital stay (29/53, 54.7%), use of oxygen therapy (19/53, 35.8%), and diabetic ketoacidosis in 2 patients (3.7%) Amphotericin B (liposomal form) was the primary therapy in all 53 patients. Hypokalemia (8/53, 15.0%) was seen as side effect of amphotericin-B although renal functions were normal in all patients. Surgical debridement was performed in 43(77.3%) patients and transcutaneous retrobulbar amphotericin-B (TRAMB) was given in 16 patients (30.1%). Total mortality in our study is of 9 patients (16.9%). Conclusions Diabetes mellitus was the dominant predisposing factor in all forms of mucormycosis which also includes newly diagnosed diabetes. Hyperglycemia and immune dysregulation by SARS-CoV-2 and high dose corticosteroid use on large scale served a favorable environment for this invasive fungus.
{"title":"Mucormycosis—The Rising Epidemic in a Pandemic: An Observational Case Study in a Tertiary Care Hospital","authors":"Priyanka Verma, R. Sahoo, A. Ahuja, Nutan Dixit, T. Dewan, A. Mammel","doi":"10.1177/26339447221138183","DOIUrl":"https://doi.org/10.1177/26339447221138183","url":null,"abstract":"Mucormycosis is a rare and ominous fungal disease caused by the order Mucorales fungi. As per Indian data, uncontrolled diabetes is the main risk factor associated with mucormycosis. But during this SARS COV-2 pandemic, a huge rise in the number of mucormycosis cases has been observed in different states in India in last 10-12 months in the second wave. The immune dysfunction caused by this virus and the use of high doses of steroids appears to be a double-edged sword and causes immunosuppression with hyperglycemia, increasing the risk of secondary bacterial and invasive fungal infections (IFIs). Objective We conducted a prospective observational study involving individuals with proven mucormycosis in ABVIMS & Dr RML Hospital, New Delhi. The demographic profile with various clinical presentations, histopathological findings, predisposing factors, management, and final outcomes were recorded. Results We included 53 patients in our study. Rhino-orbital-cerebral mucormycosis was the most common (21/53, 39.6%) presentation followed by rhino-orbital (17/53, 32.0%), rhino-cerebral (10/53, 18.8% ) rhinosinusitis (4/53, 7.5%) and pulmonary involvement in 1/53, (1.8%). The cutaneous involvement was seen in 8 patients (15.0%), disseminated mucormycosis as meningitis in 2 patients (3.7%), and dual fungal infection with aspergillosis was seen in 2 patients (3.7%). The predisposing factors being diabetes mellitus (40/53, 75.4%), with newly diagnosed diabetes in previously undiagnosed (10/ 53, 18.8%), SARS-COV-2 (33/53, 62.2%), steroid intake (30/53, 56.6% ), prolonged hospital stay (29/53, 54.7%), use of oxygen therapy (19/53, 35.8%), and diabetic ketoacidosis in 2 patients (3.7%) Amphotericin B (liposomal form) was the primary therapy in all 53 patients. Hypokalemia (8/53, 15.0%) was seen as side effect of amphotericin-B although renal functions were normal in all patients. Surgical debridement was performed in 43(77.3%) patients and transcutaneous retrobulbar amphotericin-B (TRAMB) was given in 16 patients (30.1%). Total mortality in our study is of 9 patients (16.9%). Conclusions Diabetes mellitus was the dominant predisposing factor in all forms of mucormycosis which also includes newly diagnosed diabetes. Hyperglycemia and immune dysregulation by SARS-CoV-2 and high dose corticosteroid use on large scale served a favorable environment for this invasive fungus.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"73 1","pages":"12 - 18"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88965031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1177/26339447221114676
C. Gayathri, B. Keerthana, D. Jahnavi, C. Monika, G. Srilakshmi, B. Lakshmi, P. Aishwarya, R. Ram, V. Kumar
Serum phosphate level reference range in adults is 2.5 mg/dL to 4.5 mg/dL and in children is 3 mg/dL to 6 mg/dL. The causes of hyperphosphatemia fall into four categories. These are decreased renal excretion of phosphorus, exogenous phosphorus administration, redistribution of phosphorus, and pseudohyperphosphatemia. We report a 69-year-old gentleman presented with the history of swelling of feet and facial puffiness of 1 month duration. He had renal failure with normal sized kidneys. Serum phosphorus was high. Advanced investigations revealed plasma cell proliferative disorder (clonal bone marrow plasma cells >10%) on bone marrow examination, presence of M band at the junction of beta-2 and gamma region, and elevated serum IgG and serum beta-2 microglobulin. Hyperphosphatemia in multiple myeloma may be true, or pseudohyperphosphatemia. Diligent history, examination, and investigations have yielded the possibility of pseudohyperphosphatemia owing to multiple myeloma in our patient. The interference with the phosphomolybdate ultraviolet assay for serum phosphorus estimation is one of the reasons of pseudohyperphosphatemia in multiple myeloma. The other mechanism of pseudohyperphosphatemia could be the direct binding of paraprotein to phosphorus.
{"title":"Hyperphosphatemia: A Clue to Diagnosis","authors":"C. Gayathri, B. Keerthana, D. Jahnavi, C. Monika, G. Srilakshmi, B. Lakshmi, P. Aishwarya, R. Ram, V. Kumar","doi":"10.1177/26339447221114676","DOIUrl":"https://doi.org/10.1177/26339447221114676","url":null,"abstract":"Serum phosphate level reference range in adults is 2.5 mg/dL to 4.5 mg/dL and in children is 3 mg/dL to 6 mg/dL. The causes of hyperphosphatemia fall into four categories. These are decreased renal excretion of phosphorus, exogenous phosphorus administration, redistribution of phosphorus, and pseudohyperphosphatemia. We report a 69-year-old gentleman presented with the history of swelling of feet and facial puffiness of 1 month duration. He had renal failure with normal sized kidneys. Serum phosphorus was high. Advanced investigations revealed plasma cell proliferative disorder (clonal bone marrow plasma cells >10%) on bone marrow examination, presence of M band at the junction of beta-2 and gamma region, and elevated serum IgG and serum beta-2 microglobulin. Hyperphosphatemia in multiple myeloma may be true, or pseudohyperphosphatemia. Diligent history, examination, and investigations have yielded the possibility of pseudohyperphosphatemia owing to multiple myeloma in our patient. The interference with the phosphomolybdate ultraviolet assay for serum phosphorus estimation is one of the reasons of pseudohyperphosphatemia in multiple myeloma. The other mechanism of pseudohyperphosphatemia could be the direct binding of paraprotein to phosphorus.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"12 1","pages":"28 - 31"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78020163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-06-01DOI: 10.1177/26339447221136370
S. R. Mohammed, Narine Mack, Kirk Ramharack, Jessica Rampersad
A 34-year-old woman presented with a 3-day history of dyspnea. She denied any preceding fever, night sweats, cough, pleurisy, or coryzal symptoms. She was maintained on sodium valproate 800 mg b.i.d., phenytoin 100 mg o.d., folate 5 mg o.d., and clonazepam 2 mg nocte for a known seizure disorder. Clinical examination and radiologic imaging revealed a large left-sided pleural effusion with the associated collapse of the left lower lung lobe. A chest tube was inserted for diagnostic and therapeutic purposes and ≈500 mls of serous fluid was drained. The pleural fluid analysis confirmed an exudative pleural effusion. Extensive evaluation excluded known causes of exudative pleural effusion, and a diagnosis of sodium valproate-induced pleural effusion was made. Sodium valproate was tapered off and topiramate was added to the patient’s antiepileptic regimen. We recommend physicians be cognizant of sodium valproate-associated pleural effusion, even in the setting of chronic use.
{"title":"Sodium Valproate-induced Eosinophilic Exudative Pleural Effusion","authors":"S. R. Mohammed, Narine Mack, Kirk Ramharack, Jessica Rampersad","doi":"10.1177/26339447221136370","DOIUrl":"https://doi.org/10.1177/26339447221136370","url":null,"abstract":"A 34-year-old woman presented with a 3-day history of dyspnea. She denied any preceding fever, night sweats, cough, pleurisy, or coryzal symptoms. She was maintained on sodium valproate 800 mg b.i.d., phenytoin 100 mg o.d., folate 5 mg o.d., and clonazepam 2 mg nocte for a known seizure disorder. Clinical examination and radiologic imaging revealed a large left-sided pleural effusion with the associated collapse of the left lower lung lobe. A chest tube was inserted for diagnostic and therapeutic purposes and ≈500 mls of serous fluid was drained. The pleural fluid analysis confirmed an exudative pleural effusion. Extensive evaluation excluded known causes of exudative pleural effusion, and a diagnosis of sodium valproate-induced pleural effusion was made. Sodium valproate was tapered off and topiramate was added to the patient’s antiepileptic regimen. We recommend physicians be cognizant of sodium valproate-associated pleural effusion, even in the setting of chronic use.","PeriodicalId":40062,"journal":{"name":"Journal, Indian Academy of Clinical Medicine","volume":"38 1","pages":"39 - 41"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86934677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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