Iron Homeostasis in Patients with Nonalcoholic Fatty Liver Disease

Introduction: Serum ferritin correlates with hepatic iron deposition in patients with Non Alcoholic Fatty Liver Disease (NAFLD). Iron removal improves insulin sensitivity thereby delaying the onset of type 2 diabetes mellitus, improves liver function and NAFLD histology. Objectives: This study was done to assess the iron status in NAFLD patients and its association with fibrosis and metabolic syndrome in NAFLD. Material and Method: The study was conducted in the Department of Medicine, GTB Hospital, Delhi from November 2017 - October 2019. It was an Analytical, comparative study. Forty patients with NAFLD were selected in the study group and forty healthy subjects with no evidence of fatty liver on ultrasound were selected in the control group. The level of iron parameters recorded in NAFLD patients and the control group were compared using independent t test and p value of <0.05 was considered statistically significant. Assessment of association of various parameters of iron status with the presence of Metabolic Syndrome and fibrosis in NAFLD patients was done using the Chi-Square test. Result: The parameters of iron status namely serum iron, serum ferritin, transferrin saturation and serum hepcidin were found to be higher in NAFLD patients when compared to controls. This study also observed that there was a statistically significant positive association of serum ferritin with the presence of MetS in NAFLD patients. The study also found that serum hepcidin and serum ferritin have a significant positive association with fibrosis in NAFLD. Discussion: Assessment of iron status in NAFLD may help in early identification of individuals at high risk of fibrosis and other complications like Mets. Application of iron removal strategies like phlebotomy in such patients might improve IR and NAFLD.

Prevalence of Non-Communicable Diseases in Schedule Caste dominated Rural Areas of Bhopal District, Madhya Pradesh

Introduction: Non-communicable diseases (NCDs) are the result of a combination of genetic, physiological, environmental and behavioral factors. Forty-one million people die each year due to NCDs, which is equivalent to 71% of all deaths globally. Objective: The study was done to estimate the prevalence of non-communicable diseases among five villages in the rural area of Bhopal, Madhya Pradesh, India. Methodology: The present study was an observational study carried out on 6516 patients visiting mobile healthcare OPD conducted under Schedule Caste Sub-Plan in schedule caste dominated villages (Kurana, Kalkheda, Bagoniya, Toomda and Dhamarra) of Bhopal, Madhya Pradesh. Results: It was found that 49.82% of the people from these villages were suffering from non-communicable diseases. Conclusion: Nearly half of the population of this rural area was suffering from NCDs, therefore, people of rural areas are equally vulnerable to have NCDs. Urbanisation of lifestyle in rural population, poor education level and low economic status were the contributing factors.

Post-COVID-19 Pulmonary Fibrosis: An Update

Coronavirus disease 2019 (COVID-19) is caused by a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The most common cause of hospitalisation for COVID-19 is interstitial pneumonia that may be complicated by Acute Respiratory Distress Syndrome (ARDS). With an increasing magnitude of COVID-19 survivors, post-COVID interstitial lung disease and pulmonary vascular disease are likely to be the most important long term respiratory complications. Data from previous coronavirus infections such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS), as well as emerging data from the COVID-19 pandemic, suggest that there could be substantial pulmonary fibrotic consequences following SARS-CoV-2 infection. Thus, the long-term consequences of COVID-19 appear crucial. Here, we have discussed the pathogenesis, natural history, and radiological aspects of such patients and the possible predictors which might lead to the development of lung fibrosis. Older age, severity of illness, prolonged ICU stay, history of smoking and alcoholism are few of the risk factors for the development of post-COVID-19 pulmonary fibrosis. Therapeutic options like antifibrotic drugs such as pirfenidone, nintedanib, pulmonary rehabilitation, SARS-COV-2 vaccine etc. have been described. The role of steroids and antifibrotics in the prevention of post-COVID fibrosis is still controversial. Careful longitudinal follow-up of multiple cohorts of post-COVID-19 survivors with serial lung function testing and imaging is required to complete the knowledge about natural history of the disease and the response to various therapies.

To Study the Prevalence of Osteopenia and Osteoporosis in Patients with COPD and to Correlate Severity of COPD with Prevalence of Osteopenia and Osteoporosis

Chronic Obstructive Pulmonary Disease (COPD) is a chronic respiratory airway disease characterized by both pulmonary and systemic inflammatory response and associated extra-pulmonary complications. Female gender, age and smoking are common pathogenic risk factors for both COPD and osteoporosis. Many other factors like low daily physical activity, chronic malnutrition, hypogonadism, vitamin D deficiency and chronic steroid therapy are risk factors for osteoporosis. Objectives: The study was done to evaluate the prevalence of osteopenia and osteoporosis in patients of COPD and to correlate the severity of COPD with osteopenia/ osteoporosis. Material & Method: The study was conducted at a tertiary care hospital in Delhi after ethical clearance from institutional review board. Total of 76 patients of both genders were taken. COPD diagnosis and staging was done as per Global Initiative for Chronic Obstructive Lung Disease (GOLD) criteria. Bone mineral density (BMD) was evaluated by DEXA scan in all patients. All data was entered in preformed data sheets. Statistical analysis for association of COPD with osteoporosis was done by chi-square test. Result: Mostly patients were having either osteopenia or osteoporosis, only 6% patients were having normal BMD. COPD stage III-IV were having significant bone mass loss. Those having long smoking history were more osteoporotic as compared to others. Conclusion: There is a very high prevalence of osteopenia and osteoporosis in COPD patients especially those with prolonged smoking history, GOLD stage III-IV. 35.5% of COPD patients had osteopenia and 57.9 % had osteoporosis.

A Case Report of Severe Hypokalemic Quadriparesis as the First Manifestation of Type 1 RTA in Primary Sjogren’s Syndrome

Primary Sjogren’s syndrome is an autoimmune disorder primarily involving the exocrine glands but it can have a varied presentation. It can also present without classically described sicca symptoms. One-third of the patients experience extra-glandular involvement in the form of nonspecific arthralgia, myalgia, arthritis, parenchymal involvement of renal parenchyma, lung, and rarely nerves. Renal involvement in primary Sjogren’s can present with type 1 renal tubular acidosis (RTA) and is associated with a normal anion gap and hypokalemia. We, hereby, report a case of primary Sjogren’s syndrome presenting with type 1 RTA with hypokalemic quadriparesis as the first presenting feature.

Unusual Neurological Manifestation of Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in a Postpartum Woman: A Case Report

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for the global spread of the disease (COVID-19) at present. Our understanding of the impact of the virus on the nervous system is limited. The involvement of CNS and neurological manifestations reports are further limited in obstetrical cases. We are reporting a case of an unusual presentation of COVID-19 infection in an admitted P2L2 postpartum woman who developed multiple episodes of seizures on postpartum day 8 of lower segment caesarean section, with no prior history of seizures or hypertension. This report will add to a rare neurological manifestation of COVID-19 in pregnancy.

Microbiological Profile and Antibiotic Sensitivity Pattern of Bacteria in Diabetic Foot Ulcers in a Tertiary Care Hospital

Introduction: Diabetic foot is any foot pathology due to diabetes or sequelae of diabetes mellitus. This study was conducted to identify the common microorganisms isolated from diabetic foot and to analyse the antibiotic susceptibility pattern of bacteria isolated from diabetic foot. Materials and Method: The study was a hospital based cross-sectional study where 146 foot ulcer samples (who had type 2 diabetes) were analysed. Swabs were collected from the edge and margins of ulcers, and organisms were identified by gram staining culture and biochemical reactions. Result:Out of 146 patients, 69 specimens showed growth of organisms. Total 84 aerobic organisms were isolated and out of them, 64 cases showed bacterial growth, in which 84 bacteria were isolated, which represented an average of 1.28 organisms per case. Among these organisms, 62 gram-negative and 22 gram-positive organisms were isolated. E. coli was the most common gram-negative isolate (23.81%), followed by Pseudomonas aeruginosa (21.4%), and Klebsiella pneumonia(8.33%), while among gram-positive bacteria, S. aureus was the most common isolate (22.6%). Conclusion: Incidence of growth was 47.2% in which E. coli (23.8%) was the most common isolate. Gram-negative bacteria were more common than gram-positive bacteria. Diabetic foot infections are polymicrobial in nature.

Long Term Health Sequelae of COVID-19: A Review

The outbreak of Coronavirus disease 19 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was declared a pandemic by World Health Organization (WHO) on 11th March, 2020. COVID-19 infection predominantly manifests as pulmonary symptoms that may progress to acute respiratory distress syndrome. The data on extra-pulmonary manifestations of acute COVID-19 are available. Most patients who have COVID-19 recover well within months. Currently, more than 50 million people have recovered globally. Many reports of patients with persistent severe symptoms and significant end-organ damage after SARS-CoV-2 infection have also been observed. As COVID-19 is a relatively new disease, future sequelae aren’t well established. Major adverse outcomes were found to affect different body systems: respiratory system (lung fibrosis and pulmonary thromboembolism), cardiovascular system (cardiomyopathy), and neurological system (sensory dysfunction and stroke). Mental health of COVID-19 patients were also found to be adversely affected. This review describes the effects of SARS-CoV-2 taking into account the previous experiences with SARS-CoV-2 and the Middle East Respiratory Syndrome (MERS) coronavirus that caused SARS in 2003 and MERS in 2012 respectively. This review aims to update on the long-term sequelae of SARS-CoV-2 infection and highlight the necessity for patient monitoring following the acute stage of infection with SARS-CoV-2 to provide ground for the prevention, diagnosis, and management of these potential long-term sequelae and to complete the natural history of COVID-19.

Guillain Barre Syndrome in a Young Man with SARSCoV-2: A Rare Association

Guillain Barre Syndrome (GBS) is usually a post-infectious autoimmune disease that manifests as acute ascending flaccid paralysis. The disease is usually uncommon. However, recently it was reported in a few COVID-19 cases before complete resolution of COVID symptoms. An association between olfactory-gustatory disturbances and sensory abnormalities is frequently observed in GBS with COVID-19. The electrophysiological studies usually reveal a demyelinating pattern. Respiratory involvement, as part of respiratory muscle paralysis or COVID-19 pneumonia, is associated with poor recovery in affected patients. Here, we present a case of a young man, pre-morbid healthy, who presented with GBS with mild COVID-19 infection. He successfully recovered after treatment with Intravenous immunoglobulin IVIg.