Ocular associations in hyperlipidaemia: A rural hospital based study

The incidence of hypercholesterolemia is ever increasing as the co morbid conditions such as diabetes mellitus, hypertension, stressful life is on a rise. Ocular conditions associated with hypercholesterolemia are issues which are minimally discussed. : This prospective cross-sectional study was conducted from January 2019 to June 2019. Complete eye examination was performed including visual acuity examination, refraction, tear film evaluation, slit lamp examination, measurement of intraocular pressure using rebound tonometer, gonioscopy, direct and indirect ophthalmoscopy Total of 81 patients were examined, out of which males were 55, females were 26. Most common ocular finding was Xanthoma and Xanthelasma in 61(70%) patients. Arcus juvenalis was noted in 12 (14.63%), Lipid keratopathy in 23(29.26%). Other comorbidities associated were Hypertensive Retinopathy, diabetic retinopathy, Pre senile cataract, Primary open angle Glaucoma, Branch retinal vein occlusion which has indirect causal relationship. Along with systemic workup, Hypercholesterolemia also warrants a routine detailed ocular examination even if the patient is asymptomatic. This aids in early diagnosis and management of the co-existing ocular morbidities.

Cardiovascular Disease, Cancer and Multimorbidity Interactions: Clinical Implications

Background: With the aging population, the frequency of cardiovascular disease (CVD), cancer and other morbid conditions are increasing dramatically. In addition, one disease may affect the other leading to a vicious cycle. Summary: With aging, the function of organs and systems of the human body decline including the autoimmune system resulting in a diminished response to various pathogens and a chronic inflammatory process; these changes, in addition to other risk factors, contributes to the development of multiple morbid conditions including CVD and cancer. Multimorbidity in the elderly has become the rule rather than the exception today. Further, this association between CVD and cancer, at least partially, is explained by both diseases sharing common risk factors and from accelerated vascular aging due to cancer and its associated therapies. Multiple studies have shown that the incidence of cancer is much higher in patients with CVD compared to the general population. These associations among CVD, cancer and their connection to systems of the human body provide an opportunity for novel therapies. Development of new drugs should be addressed to focus on multiple systems and not just only to one disease. Further, collecting information from registries and processing large amounts of data using artificial intelligence may assist the clinician when treating an individual patient in the future. Key messages: As the aging population increases, CVD, cancer and multimorbidity will continue to constitute a major health problem in the years to come. The physician who is taking care of such a patient, in addition to knowledge, requires clinical wisdom, clinical experience and common sense in order to apply the continuous evolving knowledge to the individual patient.

Giant Mushroom-like Neglected Basal Cell Carcinoma of the Shoulder with Spontaneous Bleeding: A Successful Surgical Approach

Introduction: Giant basal cell carcinomas (GBCCs) are extremely rare and typically more aggressive than their predecessor subtype. GBCCs with mushroom-like morphology have rarely been reported, with only one other case identified in the literature. Here we present a unique case of a neglected giant mushroom-like BCC that was treated successfully. Case description: An 81-year-old male patient presented with a large ulcerative mass on his back. He had a medical history of chronic heart failure and atrial fibrillation, which were controlled with heart medication. During a routine visit to change the dressing of the lesion, the central pedunculated stalk underwent spontaneous haemorrhaging which led to massive blood loss. The patient was treated for shock and the lesion was completely excised under emergency surgery. The tumour was sent for histopathological assessment after complete surgical removal. Recovery was successful with good postoperative results and no recurrence was reported in the 12 months following discharge. Discussion: The patient was under long-standing anticoagulant therapy that contributed to the untimely rupture of the pedunculated lesion and led to spontaneous heavy haemorrhaging. Treatment for such giant lesions can be complex, especially in patients with co-morbid conditions. Careful assessment and early treatment are paramount for successful results. Conclusion: Complete removal of such lesions is very successful for treating GBCCs.

Assessment of Post Vaccination Symptoms Following COVID-19 Vaccination in India: A Cross-Sectional Descriptive Study

Introduction: The recent examples of newly emerged diseases that causes alarming situation globally include H1N1, Congo Hemorrhagic fever, Ebola virus diseases, Nipah Virus Infection, Lassa Fever and newly declared global emergency pandemic SARS nCOVID-19 infection. Since its emergence, it has spread around the globe. It tends to spread by the inhalation of the respiratory aerosols, direct human contact. Materials and Methods: This analytical study was carried out among the healthcare workers and people who received either of Covishield or Covaxin. The online survey questionnaire was prepared and data obtained through the responses to the survey proforma. Results: 86.17% respondents were above 40 years, 69.15% males and 30.85% were females. 89.36% were vaccinated with Covishield and 10.64% by Covaxin. 75.53% respondents experienced post vaccination symptoms; commonest were the local pain at injection site (28.72%), fever (12.76%), Myalgia (12.77%). The symptoms were found more in respondents with any of co-morbid condition. Discussion: Covishield was used more commonly than Covaxin in study samples. The symptoms following vaccination were more common in 40-60 age group and persons with co-morbid conditions.

Serum Diethyl Phthalate Levels in Infertile Females with Endometriosis

Background: Endometriosis has a complex multifactorial pathophysiology and is a leading cause of female infertility. Emerging evidence suggests the role of endocrine disrupting chemicals and environmental factors such as Diethyl phthalate (DEP) in the pathophysiology of the disease. Aim: To investigate the serum DEP levels in females with infertility having endometriosis and normal healthy counter parts. Methods: Married females (n=50) age 20-40 years, diagnosed with endometriosis and having history of >1 year of infertility, were selected as cases. Age matched women (n=50) with proven fertility and screened negative for endometriosis were included as controls. Females on any medicine, having co morbid conditions were also excluded from the study. DEP concentration in serum was determined by using High performance liquid chromatography (HPLC). Results: Significantly higher levels (p=0.003) of DEP were seen in endometriosis females (3.76± 1.28 ng/ml) as compared to controls (2.61± 1.72 ng/ml). The comparison of DEP levels between different stages of endometriosis revealed an increasing, but no significant trend with advancement of the disease. Conclusion: High serum DEP levels in patients substantiate their role in disease pathophysiology. Therefore, it may be advisable to pay attention while using such compounds. There is an increased need to regulate the levels of such industrial compounds manufactured for daily use of human beings by efficient and judicious quality assurance plastics and by using the standards set by WHO and/or FDA. Keywords: Phthalate, Endometriosis, Diethyl phthalate, plasticizers, Infertility

Liver Transplantation – A Case Report

Liver transplantation is a treatment option for patients with End-stage Liver disease for whom all possible modes of surgical and medical treatment have been exhausted. The indications for Liver transplantation can be either acute or chronic liver disease. The absolute contra indications are active alcohol or substance abuse, severe cardiopulmonary or other co morbid conditions that would preclude meaningful recovery after transplant. Patients are listed on the waiting list according to their blood type and Model of End- Stage Liver Disease (MELD) score. The surgical procedure entails the excision of both donor and recipient livers and transplantation of the donor liver into the recipient (Orthotopic Liver Transplantation). This article gives an overview about liver transplantation and its management. A case report is presented and the nursing care has been discussed in detail.

STUDY OF DEMOGRAPHIC ANALYSIS, CLINICAL CHARACTERISTICS, DIAGNOSIS, MANAGEMENT AND COMPLICATIONS IN COVID-19 PATIENTS

Objective: To study the demographic analysis, clinical characteristics, diagnosis, and management in covid-19 patients. To assess the complications in covid-19 patients. Methods: A retrospective observational single centered study is carried out to study the demographic analysis, clinical characteristics, diagnosis, management, and complications in covid-19 patients. Results: Among 100 covid-19 patients 58% were male and 42% were female. Percentages of age group between 60-70 years (27%), 50-60 (20%), 40-50 (16%), 70-80 (16%), 30-40 (8%), 20-30 (5%), 80-90 (4%), and 10-20 (4%). Co-morbidities were diabetes (44%), hypertension (28%), CAD (21%), thyroid (19%), COPD (12%), anemia (8%), and renal impairment (4%). Signs and symptoms were fever (88%), cough (80%), SOB (72%), fatigue (68%), myalgia (60%), loss of appetite (52%), cold (24%), loss of smell and taste (20%), diarrhea and vomiting (12%). (97%) of the patients had two or more symptoms. Diagnostic test include RT-PCR (100%), HRCT (100%), O2 saturation (99%), D-dimer (65%), c-reactive (60%), Procalcitonin (60%), and also LDH, IL-6,PT, INR, ferritin, CBP, WBC. Treatment includes antiviral (100%), antibiotics (100%), corticosteroids (73%), immunosuppressant (54%), and antihypertensive, antidiabetic, Antiplatelets, bronchodilators, vitamins, and mineral supplements. Conclusion: Covid-19 infects the males more and average ages of 65 years are at risk. Hypertension and diabetes were most common co-morbid condition. Fever and cough are major followed by weakness sob and cold. RT- PCR and HRCT are accurate tool to detect covid-19. Although standard treatment is not yet available antibiotics and antiviral are used followed by corticosteroids. Majority of the patients have mild and moderate injection and with the lowest death rate. Older age and co-morbid conditions are major risk factors.

Rapid Clinical Screening and Staging for COVID-19 Severe Outcome - A Hospitalization Study in New York City

Background: We aimed to evaluate the risk factors for Coronavirus disease 2019 (COVID-19) related severe outcome (in-hospital death) among the hospitalized patients in New York State (NYS) and proposed a method that could be used to inform future work to develop clinical algorithms and predict resource needs for hospitalized COVID-19 patients. Methods: We analyzed covid-19 related hospitalization in NYS from April 1st to November 17th, 2020, using Statewide Planning and Research Cooperative System (SPARCS) discharge dataset. Logistic regression was performed to evaluate the risk factors for COVID-19 related in-hospital death using demographic variables, symptom, rapid clinical examination, and medical history of chronic co-morbid conditions. Receiver operating characteristic (ROC) curve was calculated, and cut-off points for predictors were selected to stage the risk of COVID-19 related fatal outcome. Results: Logistic regression analysis showed age was the greatest risk factor for COVID-19 related fatal outcome among the hospitalized patients, which by itself achieved the diagnostic accuracy of 0.78 represented by the area under the ROC curve. By adding other demographic variables, dyspnea or hypoxemia and multiple chronic co-morbid conditions, the diagnostic accuracy was improved to 0.85. We selected cut-off points for predictors and provided a general recommendation to categorize the levels of risk for COVID-19 related fatal outcome. Conclusions: We assessed risk factors associated with in-hospital COVID-19 mortality and identified cut-off points that might be used to categorize the level of risk. Further studies are warranted to evaluate laboratory tests and develop laboratory biomarkers to improve the diagnostic accuracy for early intervention.

Healthcare Disparity and Comorbidity Burden in Heart Failure Patients Over the Age of 80

The healthcare industry is currently struggling with providing access and coverage for a rapidly ageing and increasingly diverse population with multiple co-morbid conditions. This retrospective study analyzed the electronic health records of elderly heart failure patients (age range 80-103; mean 87 ±4.9) for common co-morbid conditions of hypertension, hyperlipidemia, dementia and diabetes mellitus. Chart review analysis of 316 patients showed a racial distribution of 251 White vs. 65 Black patients (79% vs. 21%). Male patients were under-represented (B= 13.8% and W= 26.3%). Females patients predominated (B= 86.2% and W= 73.7%). Overall, the prevalence of all four comorbidities was approximately three times higher in Blacks (18.5%) vs. White (7.2%). The proportion of Blacks and Whites with HTN and was comparable at 98.5 and 92.4% respectively. Hyperlipidemia was present in 84.6% Black and 63.3% White. The diagnosis of diabetes was higher in Blacks, 41.5% compared to Whites, 21.9%. The greatest disparity was in the diagnosis of dementia which was higher in Blacks, 61.5% vs Whites, 44.6%. Our study is unique for studying healthcare disparity in octogenarian and nonagenarian residing in a rural setting. Our results also highlight the importance of making a special effort to engage older Black patients in seeking healthcare in addition to designing strategies to reduce barriers that impede access and availability of resources and clinical care, especially in economically underserved regions of the country.