Curious case of Retrosternal Colloid Goitre

Background: Retrosternal goitre is considered to be a rare entity. It is a slow growing enlargement of the thyroid gland which remains asymptomatic for many years. Symptoms are mainly due to compression of airways and oesophagus. Surgical management with the removal of the involved lobe is considered sufficient. Summary: Here we report a case of a 33 yrs. old lady who presented to us with complaints of neck pain, facial flushing, difficulty in breathing and vague body ache. Clinical examination was within normal limits. The patient was referred to orthopedician for further evaluation. MRI cervical spine was done which was suggestive of large swelling in left lobe of thyroid with retrosternal extension causing deviation of trachea to opposite side. FNAC was done which was inconclusive. The involved lobe was removed surgically with frozen section suggestive of Colloid goitre. Conclusion: Retrosternal goitre are slow growing enlargement of thyroid gland which may present with vague symptoms, best managed surgically often followed relief from the symptoms post-surgery.

Falciparum malaria associated acute kidney injury with polyneuropathy and intra-arterial thrombosis (stroke)

Background Malaria is still major problem in developing countries, such as Pakistan. Besides fever, body ache and vomiting it can present with acute kidney injury, proteinuria, hematuria and cerebral manifestations which are more common with falciparum malaria. Neurological manifestations are rare presentation of malaria and should be consider in patients who are admitting with features of neuropathy and stroke. Case presentation We describe an unusual case of falciparum malaria, complicated by acute kidney injury who developed Polyneuropathy and intra-arterial thrombosis in middle cerebral artery territory. Our patient recovered his renal functions during admission and recovered his power and sensation in his limbs as well after 1 month. Conclusion Malaria cause neurological manifestations including axonal and sensory neuropathy, cerebral venous and arterial thrombosis, PMNS, cerebellar signs and symptoms, psychosis, etc. With prompt diagnosis and early treatment they can be cure and regain their motor and sensory functions to normal level.

Case Report on Sickle Cell Anemia

Introduction: Sickle cell anemia is a kind of anemia caused by a virus a homozygous HbS mutation (HbSS). Sickle cell disease (SCD) is a congenital blood illness that has an impact children. It is inherited from a parent’s DNA. SCD patients produce an abnormal kind of hemoglobin. This is the oxygen-transporting protein found in red blood cells. SCD causes a lack of oxygen in organs and tissues of the body. Clinical Findings: Fever, Cough and cold, pain in lower extremities, Bodyache , Fatigue and Anemia (6.3 gm/). Diagnostic Evaluation: Blood test: Hb -6.3gm%, Total RBC count -2.2millions/cu mm, RDW- 18.2%, HCT-20.2%, Total WBC count 3000/cu mm, Monocytes 02%, Granulocytes 20%, Lymphocytes 77%, AST(SGOT) – 110 UL. Peripheral Smear: RBC mild hypochromic with mild cytosis which show few microcytic and mildly Hypochromic. Platelets – Reduced on smear, APC -60,000 cells. Ultrasonography: Splenomegaly. Therapeutic Interventions: Blood transfusion, Inj. Cefotaxime 750 mg IV x BD, Syr. Azee 4ml x OD, Tab. Folic Acid 5 mg x OD, Tab. Udiliv 150mg x BD, Cap. Hydra 500 mg x OD. Outcome: After treatment, the child show improvement. His fever and body ache, cough and cold fatigue and pain in hands and leg were relieved and his Hb% increased from 6.4 gm% to 11 gm% after blood transfusion. Conclusion: My patient was admitted to Pediatric Ward No- 22 in AVBRH with a known case of SCA kind of anemia a body in which he had complaint fever and body ache, cough and cold fatigue and pain in hands and leg. After getting appropriate treatment his condition was improved.

Assessment of breakthrough infections among post-vaccinated healthcare workers in a Tertiary Dental Hospital in New Delhi, India

Background: COVID-19 vaccination in India has been rolled out on a national level, with healthcare workers (HCWs) becoming the first recipient of both Covishield and Covaxin. However, concerns over efficacy of vaccines have been much debated. This study highlights COVID-19 infections among vaccinated HCWs in a teaching dental hospital in Delhi, India. Methodology: This cross-sectional survey was conducted using a pretested, validated, self-instituted questionnaire assessing COVID-19 like symptoms and/or confirmed infections among partially or fully vaccinated HCWs (all faculty, staff and students) of the institute from 16th January to 31st July 2021. The number of infections was also matched with hospital records. Results: Out of 397 HCWs, 386 (97.2%) were vaccinated and 355 (89.4%) had received both doses. COVID-19 like symptoms appeared in 21 HCWs (5.4%) post any dose of vaccine. Symptomatic breakthrough infections >14 days after second dose occurred was seen in 16 HCWs (4.5%). Except one (required hospitalization), all other cases had mild infection. No significant difference was observed between Covishield and Covaxin. Most common symptom was fever and body ache. Conclusion: The study identifies the possibility of breakthrough infections among vaccinated HCWs, and ensures the impact of vaccination in limiting disease severity. The findings suggest that COVID-19 preventive measures should be continued even among vaccinated individuals.

Socio-demographic and Clinical Profile of Covid-19 in Children

Introduction: The corona virus disease 2019 (COVID-19) is a pandemic disease. Infection by COVID-19 in children is not so common but gradually the numbers of children affected with COVID-19 are increasing day by day. The epidemiological importance and clinical pattern in children with COVID-19 is now a challenge to be described by the clinicians. Objectives: To describe socio-demographic and clinical characteristics of COVID-19 infected children. Material and Methods: This cross sectional observational study was conducted among 58 COVID-19 children who were admitted in COVID-19 dedicated Kurmitola General Hospital (KGH), Dhaka from March 2020 to July 2020. Their signs, symptoms, sex, age distribution, laboratory results and familial contact were analyzed. Results: Among 58 most of the children (63.8%) were in school going age (5-15years). The number of female (39) was more than male (19) and female-male ratio was 1:0.48. Most of the children (75.9%) came from urban lower middle socioeconomic group. About 84.4% children were affected from family member. Among all, (8.6%) patients had no symptoms. Main symptoms of the children were cough (36.2%), only fever (22.4%), fever with cough (8.62%) and diarrhoea (5.2%). About 12.06% of the children had additional symptoms including sore throat, nasal congestion, fatigue, headache, body ache, vomiting, abdominal pain, convulsion and rash, 6.9% had respiratory distress and one child came with convulsion. About 12.1% patients showed lymphopenia, 18.9% showed leucopenia, 13.8% patient had neutrophillia. C-Reactive Protein (CRP) and serum ferritin were high in only 12.1% and 8.6% cases respectively. There were 29.3% patients who had normal Chest X-Ray and 58.6% had mild lesion, 8.6% had bilateral consolidation and 3.4% had patchy opacities. Conclusions: COVID-19 is not so common in children and usually presents with mild form or no sign symptoms clinically and by laboratory analysis. But it is noteworthy that they may play role in transmission of disease. JAFMC Bangladesh. Vol 16, No 2 (December) 2020: 72-75

POST COVID SYNDROME; A SCENARIO TO BE TAKEN CARE OF.

BACKGROUND: COVID -19 pandemic is the most important public health problem of recent time. Tens and thousands of people have suffered with COVID-19 in last one and half year. Most people who have suffered with COVID-19 recover completely within a few weeks but majority of patients continue to have varied symptoms after initial recovery. OBJECTIVE: To assess the prevalence of Post COVID symptoms, to assess requirement of treatment and to make recommendation for Post COVID syndrome care. METHODS: Present cross-sectional study was done among patients who recovered from COVID-19 in GIMS Hospital of Kalaburagi district. Mobile numbers of COVID patients were collected from records. Total 100 randomly selected patients were contacted and information regarding post covid symptoms in between 6 weeks to 12 weeks after recovery from COVID-19 was collected. RESULT: 87%patients developed one or more post covid symptoms. Weakness was reported to be most common problem (55%), followed by body ache (26%) and neuropsychiatric symptoms such as difculty in concentration and insomnia (22%). Every fth patient reported that symptoms persisted for more than 1 month. Though most of the respondents classied their symptoms as mild and moderate (52.5% and 37.9% respectively), 47% of the symptomatic patients have to take some treatment for these symptoms. CONCLUSION: Post COVID symptoms are common but usually less severe. Many of patients required conservative management with medications. Many patients required lot of counselling. Almost one in ve patients reported that symptoms persisted for more than one month. The results highlight the need for post Covid care for COVID recovered patients.

Effectiveness of Shamak Yoga on Essential Hypertension in comparison with Atenolol: A Randomized Controlled Trial

Hypertension is responsible for many morbidities and increasing mortality in India. A lot needs to be done to find safe and yet effective treatment of hypertension. Ayurveda has no direct reference of blood pressure or hypertension in its classics, but various conditions mentioned in classical texts resembles hypertension. A poly herbal combination of ten Ayurvedic herbs called “Shamak Yoga” was in use in Pakwasa hospital, Nagpur for more than twenty five years for management of hypertension along with anxiety, palpitation and insomnia. Objective- To evaluate the effect of Shamak Yoga (SY) on essential hypertension in comparison of Atenolol. Material and Methods – thirty four clinically freshly diagnosed patients of hypertension were randomly divided in two groups. Control group was treated with Tablet Atenolol 50 mg once a day orally and experimental group was treated with SY 2 gm orally twice a day with plain water for 4 weeks. Subjective criteria and objective criteria were observed and recorded; data was analyzed statistically. Results - SY was found comparable and statistically significant effective with Atenolol for systolic and diastolic blood pressure in mild hypertensive patients. SY is most effective on symptoms like headache, giddiness, fatigue, dizziness, sleeplessness, body ache and palpitation.

Dengue Shock Syndrome Complicating High Risk Twin Pregnancy during Late Gestation: Extinguishing Fuel added Flames

Incidence of Dengue has been on the up rise ever since the second wave of the pandemic of COVID19 has ended introducing an old enemy on the frontline to the health care professionals.A 28 year old Gravida 2 Parity 0 Living 0 Abortion 1 with twin pregnancy presented with fever along with chills and retro orbital pain along with body ache since two days in the emergency department with the gestational age of 36 weeks.She tested positive for Dengue NS1 antigen.Patient was having thrombocytopenia and was managed with intravenous fluids,platelet and blood transfusion and was taken for caesarian section and she delivered twins with normal birth weight.During the post operative period the patient went into dengue shock syndrome and which was managed with fluids and inotropic support and patient ultimately recovered and was discharged on day seventeen of admission .This case report emphasises on the importance of prompt detection and management of dengue in a case of high risk pregnancy such as twin pregnancy.After extensive review of literature we found that this is the first case report to report the association of twin pregnancy with dengue shock syndrome making it an important topic of discussion.

Ashwagandha-Induced Gastric Upset in Post-Covid Patient-A Case Report and Brief Review of the Literature

Adverse drug reporting of herbal drugs is less common as they are generally considered as safe. It is also very common to use self-medication by people in the case of herbal drugs. But many times, mild to severe events have been seen with the use of herbal or ayurvedic medicines. We have reported a case of post-covid patient, who was having complained of headache, body ache, lethargy, backache, generalized weakness and excessive sweating since one weak. Patient had past history of hospitalization due to COVID-19 moderate pneumonia one month back. Patient also had history of type-2 diabetes mellitus, hypertension and dyslipidemia and was taking anti-diabetic and anti-hypertensive medications continuously. Ashwagandha powder (Withania somnifera), Maha yogaraj guggulu (herbal anti-inflammatory) and Syrup Amynity Plus (herbal immune-booster) were prescribed for these complain. Conversely, moderate severity adverse reaction like nausea, vomiting, diarrhea, and abdominal cramps were noted after the intake of suspected drug i.e. ashwagandha powder. Nevertheless, symptoms were relieved after the de-challenge. This shows a temporal relation of the event with the suspected drug. One more possibility of drug-drug interaction in this case cannot be ruled out completely. Causality assessment was done for this adverse event and it was considered as the “probable” category of the adverse event in WHO causality classification.

SARS-CoV-2 and Orientia tsutsugamushi co-infection in a young teen, Nepal: Significant burden in limited-resource countries in Asia?

Scrub typhus is caused by Orientia tsutsugamushi, transmitted through bites of infected chiggers (larval mites). During the coronavirus disease 2019 (COVID-19) pandemic, reports of co-infections with endemic pathogens are increasing around the world. Disease with similar clinical presentation may mask other disease diagnosis and increase the morbidity and mortality of the patients. We report co-infection between severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and O. tsutsugamushi in a patient in Nepal presenting with fever, headache, retro-orbital pain, generalized body ache, and knee joints pain with a history of dry cough and dyspnea at night. Since scrub typhus is prevalent and considerate as one of the public health consents in Asian countries and the possible overlapping clinical manifestation with other infections including COVID-19, a further investigation required to determine the burden of SARS-CoV-2 and O. tsutsugamushi co-infection in scrub typhus-endemic countries in Asia.