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   Table of Contents - Current issue
Coverpage
July-December 2021
Volume 11 | Issue 2
Page Nos. 1-61

Online since Tuesday, October 5, 2021

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EDITORIAL  

Newer medications in coronavirus disease-2019 (COVID-19) infection Highly accessed article p. 1
SM Baruah
DOI:10.4103/2278-8239.327551  
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ORIGINAL ARTICLES Top

Association of hematological and biochemical parameters with clinical profile of COVID-19 patients in Visakhapatnam, India p. 4
Himavathy Kodandarao Gara, Dharma Rao Vanamali, Adhikarla Surya Veeramani Kartheek
DOI:10.4103/ajoim.ajoim_5_21  
Background: The cytokine cascade in COVID-19 is responsible for its clinical manifestations. Timely management of patients with dismal prognosis may improve their clinical outcome. The study aimed to analyze the hematological and biochemical parameters among COVID-19 patients and the factors associated with laboratory changes and COVID-19 infection. Materials and Methods: A retrospective, cross-sectional study was conducted in a designated district COVID hospital. COVID-19 patient’s medical records were converted into an electronic database which included demographic data, recent exposure history, existing co-morbidities, symptoms, and laboratory findings. Results: Out of the 1340 patients, 69.25% were males. Symptomatics accounted for 57.61%. The common co-morbidities among infected patients were diabetes mellitus (13.88%), hypertension (15%), and chronic obstructive pulmonary disease/asthma (2.16%), which had a significant positive correlation with COVID-19. The common symptoms were fever (50.39%), dry cough (46.24%), dyspnea (30.7%), and myalgia (28.5%). Leucocytosis, neutrophilia, lymphopenia, and thrombocytopenia were reported in 5.22%, 11.34%, 27.16%, and 3.41% of patients, respectively. Elevated aspartate aminotransferase, alanine aminotransferase, hypoalbuminemia, and hyperglobulinemia were observed in 13.88%, 19.4%, 24.77%, and 10% of patients, respectively. Symptomatics had significantly higher values for neutrophil percentage, neutrophil–lymphocyte ratio (NLR), derived NLR, lymphocyte-to-monocyte ratio, platelet-to-lymphocyte ratio, lymphocyte–leucocyte ratio, systemic immune-inflammatory index, blood urea, and indirect bilirubin levels and significantly lower values for lymphocyte percentage, absolute lymphocyte count, and serum albumin. The logistic regression analysis revealed a significant association of deranged laboratory parameters among symptomatic COVID-19 patients and those with pre-existing co-morbidities. Conclusion: Neutrophilia, lymphopenia, and deranged liver function tests were significantly present in COVID-19 patients. The inflammation in COVID-19 is exhibited as remarkable hematological and laboratory changes whose careful interpretation can offer a clinical window for risk stratification and appropriate therapeutic interventions.
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Acute coronary syndrome (ACS) during corona virus disease-19 (COVID-19) pandemic: A single-center comparative study p. 13
Dibya K Baruah, Anuradha Darimireddi, Ravikanth Telikicherla, Suresh Allamsetty
DOI:10.4103/ajoim.ajoim_8_21  
Aim: To analyze the impact of corona virus disease-19 (COVID-19) pandemic and various containment measures taken for the pandemic control on hospital admissions of acute coronary syndrome (ACS). Materials and Methods: This study is a single-center, comparative study conducted at a tertiary care center situated in the southern part of India. The study period was from March 1, 2020 till May 31, 2020, including the first lockdown period in India. All patients admitted with a diagnosis of ACS to our hospital during the study period were included in the study (study group). This group was compared with the patients admitted with ACS into our hospital during the corresponding period of the previous year (control group). Patients with ST-elevation myocardial infarction (STEMI) were compared with the control group for clinical profile, treatment, hospital course, outcome, and incidence rate ratio (IRR) of admissions. Results: There was a significant reduction of mean daily admissions of ACS cases in the study group with IRR of 0.702; 95% confidence interval (CI), 0.719–1.02; P < 0.001. The reduction rate of ACS cases was 29.74% (study period, n = 215; control period, n = 306), and it was mostly related to a decline in the number of non-ST-elevation myocardial infarction (NSTEMI) and unstable angina. No significant reduction of patients with STEMI was observed between the groups. However, patients with STEMI had more left ventricular (LV) dysfunction, LV thrombus, and a significantly higher incidence of mitral regurgitation (13.3% vs. 8.8%, P < 0.05). The impact of the COVID-19 outbreak on the patients with ACS revealed a parallel reduction of hospital admissions with an increasing number of COVID-19 cases in the community. Conclusion: The COVID-19 pandemic and concomitant social restrictions resulted in a significant decline in hospital admissions due to ACS in this tertiary care center, but without any effect on the number of admissions with STEMI. A parallel reduction of hospital admissions for ACS cases with a rising number of COVID-19 cases in the community was also observed in this study.
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Donor selection and deferral pattern in convalescent plasma donor in plasmapheresis unit of a tertiary care hospital p. 20
Adity Sharma, Zarika Ahmed, Mustafizur Rahman
DOI:10.4103/ajoim.ajoim_4_21  
Context: The novel coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in Wuhan, China, in December 2019. The management plan is supportive care with oxygen supplementation and mechanical ventilation. US FDA approved convalescent plasma (CP) for COVID-19 for clinical trials and as an emergency investigational new drug. Although numerous trials are currently investigating the safety and efficacy of CP in COVID-19 patients, there is a paucity of ongoing and published studies evaluating the CP donors’ side. This retrospective study reports the CP donors’ selection and deferrals. Aim: To evaluate and analyze the donor deferral pattern and its causes among CP donors in a tertiary care hospital blood bank apheresis unit. Settings and Design: Hospital-based retrospective analysis. Subjects and Methods: Donors aged 18–65 years who had recovered from COVID-19 at least 4 weeks previously coming for plasma donation were retrospectively analyzed from July 25, 2020 to January 24, 2021 for a period of 6 months at blood bank apheresis unit, Assam Medical College and Hospital. Results: A total of 396 potential plasma donors were screened during the study period. The donor deferral rate was 39.1%. The permanent deferral was 36.8%, and the temporary deferral was 63.2%. The maximum number of donors deferred because of low antibody (18.7%) followed by low hemoglobin (14.8%). Associated comorbidities, low platelet count, repeat reverse transcription-polymerase chain reaction positivity, transfusion transmitted infection reactivity, intake of medicines, infections, vaccination, and underweight were other causes identified. Conclusion: The pattern of donor deferral is an important tool for blood safety and also provides key areas to focus on a demographic region or policy formulation for donor selection as well as to ensure donor safety.
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Prevalence of antimicrobial-resistant infection among patients attending Assam Medical College and Hospital, Dibrugarh p. 24
Gourangie Gogoi, Mousumi Dutta, Gargi Choudhury
DOI:10.4103/ajoim.ajoim_7_21  
Background: The burden of antimicrobial resistance (AMR) is increasing globally at an alarming rate, especially among hospitalized cases. However, there is still lack of knowledge about morbidity and mortality due to AMR infections among different populations. The present study was aimed to provide a brief insight on the prevalence of AMR infection among the patients attending Assam Medical College and Hospital, Dibrugarh, Assam, India. Materials and Methods: A retrospective cross-sectional study was conducted among the patients admitted in the hospital from April 2018 to April 2019. Blood culture reports of AMR-positive cases were collected from the Microbiology Department and hospitalization records including clinical and demographic data were retrieved from the Medical Records Department. Results: Overall, 251 blood culture reports positive for AMR infection were obtained during the study period. Of this, 96 cases (38.25%, 96/251) were females and 155 (61.75%, 155/251) were males. AMR infection was mostly prevalent among younger age group (0–1 month) with 85.65% (215/251). Methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, and Klebsiella pneumonia were the most frequently identified AMR pathogens in the study population with 31.47% (79/251), 23.90% (60/251), and 17.93% (45/251), respectively. Conclusion: The identified AMR pathogens were mostly prevalent among young infants and characterized with multidrug resistance. However, the extended study in increased population mostly among hospitalized cases may provide insights for understanding the burden of AMR and associated risk factors.
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Clinical profile of autoimmune encephalitis: Hospital-based study p. 30
Satish Bawri, Munindra Goswami, Ashok Kumar Kayal, Moromi Das
DOI:10.4103/ajoim.ajoim_2_21  
Background: Autoimmune encephalitis causes subacute deficits of memory and cognition, often followed by suppressed level of consciousness or coma. It is a difficult clinical situation due to the similarities in the clinical, imaging, and laboratory findings with many forms of other encephalitides. Materials and Methods: The aim of this article is to study the clinical profile of autoimmune encephalitis. This is a prospective observational study and conducted from August 2014 to July 2017 at Gauhati Medical College, Guwahati. Detailed neurological evaluation along with investigation was done in all the patients. Results and Observation: All patients are diagnosed and categorized as per diagnosis criteria led done by Graus et al. A total of 18 patients were included among which 13 (72%) patients were definite, 3 (16.66%) on probable, and 2 (11%) were possible. Out of the 18 patients, 8 (44%) were males and 10 (56%) were females. The average mean age was 31 ± 4 years and the duration of symptom was 7 weeks ± 4 days. Most common findings were psychiatric symptoms 16 (89%), cognitive decline and short-term memory loss 15 (83%), seizure 14 (78%), movement disorders (hyperkinetic) 13(72%), speech abnormalities 12 (67%), and autonomic dysfunction 4 (22%). Baseline investigations and cerebrospinal fluid analysis revealed pleocytosis along with neural autoantibodies positive in 13 (72%) patients. Electroencephalogram showed epileptiform discharges along with slowing. Magnetic resonance imaging is done in every patient and consistent with the finding of autoimmune encephalitis. Discussion and Conclusion: In the present study, patients presented with varied clinical features with positive neural autoantibodies. A broad approach to testing for infectious diseases and various autoantibodies can lead to the correct diagnosis.
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Complete Rockall score in predicting outcomes of elderly patients with acute non-variceal upper gastrointestinal bleeding: A tertiary care study p. 37
Ankur Bhattacharyya, Subha Lakshmi Das
DOI:10.4103/ajoim.ajoim_13_21  
Background: Upper gastrointestinal bleeding (UGIB) is a common life-threatening emergency with an overall mortality rate of around 10%. Complete Rockall score is designed to identify patients who are at greater risk of adverse outcome. The aim of this study was to assess the Rockall score as a predictor of adverse outcome in elderly population presenting with non-variceal UGIB. Materials and Methods: This study was an observational study conducted in 116 patients of age >60 years. After stabilizing the patient, endoscopy was performed using a Pentax endoscope. Severity of bleeding was assessed with complete Rockall scoring. The statistical significance was fixed at 5% level (P-value <0.05). Results: The mean age of the study population was 70.16 ± 6.01 years with male-to-female ratio of 2.63:1. Majority of patients (55.17%) presented with both hematemesis and melena. The most common lesion was duodenal ulcer (33.62%). The mean blood transfusion was 1.56 ± 1.14 U. The mean Rockall score was 4.37 ± 2.12. The mean hospitalization was 3.26 ± 1.69 days. Rebleeding occurred in 12.93% of the patients and 8.62% of the patients expired during hospitalization. Out of the 10 patients expired, 20.0% belonged to the moderate-risk and 80.0% belonged to the high-risk Rockall groups, which were found to be statistically significant (P-value <0.001). Conclusion: Acute UGIB is a medical emergency and Rockall score is ideal to stratify elderly patients to anticipate outcome and prognosis.
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REVIEW ARTICLE Top

Pathological and biochemical alteration in COVID-19 p. 42
Noni Gopal Singha
DOI:10.4103/ajoim.ajoim_17_21  
Corona virus disease 2019 (COVID-19) caused by severe acute respiratory corona virus 2 (SARS-COV-2) is mainly respiratory disease occurring since December 2019 and first detected in Wuhan province of China. The complexity of SARSCOV-2 is centered on the unpredictable clinical course of the disease that can rapidly develop causing severe and deadly outcomes. The pandemic COVID-19 is a scientific, medical, and social challenge. In this review, the basic pathological and biochemical changes in COVID-19 are described, also how it influences in predicting the disease progression thereby helping in early interventions to prevent complications.
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CASE REPORTS Top

A case of ovarian hyperstimulation syndrome with diffuse cortical necrosis p. 48
Sweety Kakoti, Dhruvajyoti Choudhury, Tonmoy Das
DOI:10.4103/ajoim.ajoim_6_21  
Ovarian hyperstimulation syndrome is an iatrogenic, serious complication of controlled ovarian hyperstimulation, usually self-limited, but occasionally life threatening and typically occurs with gonadotropin. A 32-year-old married female [Para 0+1, 30 weeks (intra-uterine death)—2016], who underwent ovum pick up procedure for secondary infertility, presented to the Department of Nephrology, Apollo Hospital, Guwahati with the complaints of pain in the abdomen, anuria, breathing difficulty, bleeding per vagina on the next day. On investigating the case, the patient had thrombocytopenia, leucocytosis, anemia, normal morphology in peripheral blood smear, raised inflammatory markers, hepatic transaminases, lactate dehydrogenase, and rapidly progressive renal failure, metabolic acidosis with negative serological markers for connective tissue disease. Radio imaging suggested bilaterally enlarged ovaries with multiple hemorrhagic cysts, pleural effusion, and ascites. Ultrasound showed normal sized kidneys with increased echotexture and hypoechoeic cortical rim. Renal biopsy showed diffuse renal cortical necrosis. Supportive management started with a target to correct volume depletion, monitoring, and electrolyte abnormalities. Patient was hemodynamically stabilised and discharged on thrice weekly maintenance dialysis.
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Secondary thrombocytopenia with primary Sjogren’s syndrome: A rare presentation p. 50
Sanchu T. K. Sreeraj, Trinayani Barua, Anupam Dutta, Sreemanta M Baruah, Balasubramanian B. V. Ramanan, Arijit Das
DOI:10.4103/ajoim.ajoim_9_21  
Primary Sjogren’s syndrome (pSS) is a chronic systemic autoimmune rheumatic disorder that is characterized by lymphoplasmacytic infiltration of the salivary and lacrimal glands. pSS is the most frequent connective tissue disorder after rheumatoid arthritis, affecting 0.3%–3% of the population. The prevalence of pSS is more common in women than men, with a sex ratio of 9:1. Occult pSS can rarely present as immune-mediated cytopenia. In this case report, we exemplify an atypical presentation of pSS that presented as thrombocytopenia. Hence, we should always consider pSS in the differential diagnosis of patients with unexplained cytopenias.
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Post-Covid cavernous sinus thrombosis with peri-orbital cellulitis, ophthalmoplegia, deep cervical vein thrombosis, sinusitis in a 24-year-old lady: A case report p. 54
Jayanta Thakuria, Arvind Kumar, Rohit Gupta, Jacquiline D Shira, Dwijen Das
DOI:10.4103/ajoim.ajoim_15_21  
A 24-year-old female presented with blurring of vision, chemosis, protrusion of eyeball, restriction of movements of right eye, numbness over the right side of the face with severe headache, stiffness of neck, and fever of 2 days duration. She gives a history of recent Covid-19 infection 3 weeks back. She was treated symptomatically and recovered fully. On examination, there was proptosis, chemosis, third, fourth, fifth, and sixth nerve palsy on the right side, and nuchal rigidity. She was started on broad spectrum antibiotics, analgesics, anticoagulant, and prophylactic antifungal thinking in line of post-Covid orbital cellulitis or mucormycosis. Her investigations revealed raised total leucocyte count and erythrocyte sedimentation rate with normal ultrasound abdomen and chest X-ray. Blood culture and culture of nasal swab and oral cavity for fungus were sterile. Contrast-enhanced magnetic resonance imaging brain, orbit, and sinus showed proptosis, myofascial edema, superior ophthalmic vein thrombosis, right cavernous sinus and deep cervical vein thrombosis, sphenoid and bilateral ethmoid sinusitis with narrow lumen of the internal jugular vein. She responded very well to the treatment. Her inflammatory parameters came down drastically and clinically, she started opening her eyes and ophthalmoplegia subsided within a week. By the 10th day she was asymptomatic. Repeat MRI showed reduction of proptosis, myofascial edema with partial recanalization of right superior ophthalmic vein, right cavernous sinus, and right deep cervical vein. She was discharged on injectable anticoagulant and antibiotics for another 10 days.
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LETTERS TO THE EDITOR Top

Quiz for journal of Association of Physicians of India Assam p. 58
Pritam Kumar Borthakur
DOI:10.4103/ajoim.ajoim_14_21  
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Mucormycosis and diabetes: Lessons from the COVID pandemic p. 60
Dewark Sharma, Bhaskar Borgohain, Bishwajit Saikia
DOI:10.4103/2278-8239.327552  
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