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COVID 19 since its onset in Wuhan in 2019 has overburdened our existing health resources and infrastructure. Dengue virus has been endemic in Asian countries since decades. Both being viruses with similar clinical profile and overlapping laboratory parameters has posed a great challenge for Asian countries to combat a co epidemic, creating a double burden. We, as clinicians must be more vigilant in diagnosing the patients so that dengue is not missed in this covid pandemic era and does not progress to life threatening dengue shock syndrome. More importantly, we should emphasize on preventive measures for prevention of dengue so that we can reduce the burden on health care system.With global resurgence of M. tuberculosis infection, cases of extra pulmonary TB have also shown an increase. Tuberculosis is a major cause of morbidity and mortality in India. Although disseminated tuberculosis can affect most of the organs, vasculitis presenting as peripheral gangrene as a manifestation of tuberculosis is very rare. We report the case of a 70 years old male who presented with gangrene of left leg complicating disseminated tuberculosis.Around 300- 400 AD, ancient Indian physicians described a condition akin to diabetes mellitus which was called "Madhumeha". Sushrutha and Charaka, are also credited with describing two types of diabetes which would roughly correspond to type 1 diabetes and type 2 diabetes. However, little is known about the history of diabetes in India between the first and 19th century AD. A thorough search of literature revealed a large number of publications on diabetes from India in the 1800s and early 1900s, mostly from Calcutta and the Madras Presidency, suggesting that the prevalence of diabetes was high in these two places. Building on the observations made by a number of English physicians, Chunilal Bose in 1907 suggested the link between diabetes and lifestyle in India. Amazingly, India did not have to wait long after the discovery of insulin by Banting and Best at Toronto in 1921, to get its own supply. Around this time, Dr. J.P. Bose, eminent physician and diabetologist from Calcutta made remarkable contributions to the study of diabetes in India. He was also the first to describe the dramatic effects of insulin administration to children with type 1 diabetes in India. All these facts have remained largely forgotten which prompted the authors to delve deep into the history of diabetes in pre-independence India. This has led to the unearthing of several pearls of knowledge which are presented in this article as a fitting tribute to the 100th year of Insulin Discovery.

The term 'Capsular warning syndrome (CWS)' refers to recurrent, stereotypical transient ischemic attacks, either motor, sensory or both, without cortical symptoms or signs. Of these patients, 42-71% go on to develop infarcts. There are no defined treatment guidelines for this lesser known entity.

We studied 9 patients who presented over last 2 years to our hospital with recurrent and stereotypical transient ischemic attacks suggestive of capsular warning syndrome. Their clinical characteristics, neuroimaging findings, relevant etiological investigations, management and outcomes were studied.

Seven out of 9 patients were under 40 years of age. KG-501 research buy The commonest presentation in our series was a pure motor syndrome. The duration of neurologic deficits ranged from 5 minutes to 20 minutes with complete recovery in between episodes. Three patients had concordant abnormalities on CT brain angiography. Five out of 9 patients received IV thrombolysis with t-PA. One patient worsened neurologically post thrombolysis, whilst the others improved clinically.

Despite multiple hypotheses, the pathogenesis and management of CWS has not been established clearly. Due to fluctuating neurological symptoms with complete recovery in between the episodes, there is a dilemma concerning treatment of such patients with intravenous thrombolysis. However, intravenous thrombolysis appears to be safe in CWS as in acute ischemic stroke, followed by treatment with antiplatelet agents.

Despite multiple hypotheses, the pathogenesis and management of CWS has not been established clearly. Due to fluctuating neurological symptoms with complete recovery in between the episodes, there is a dilemma concerning treatment of such patients with intravenous thrombolysis. However, intravenous thrombolysis appears to be safe in CWS as in acute ischemic stroke, followed by treatment with antiplatelet agents.

Infections with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have multisystemic involvement with hyperinflammation being a cardinal feature and deranged iron metabolism having a possible role. In this premise, we studied the prognostic value of two markers of iron metabolism ferritin and hemoglobin.

A retrospective-cohort study was carried out in a tertiary hospital in northern India involving 210 hospitalized COVID-19 patients aged 15-and above. Analysis was done for clinical profile, comorbidities and basic laboratory indices including ferritin-hemoglobin ratio (FHR) with primary end-point being in-hospital all-cause mortality.

Median serum ferritin levels (640.00ng/mL vs 220.00ng/mL) were significantly higher among non-survivors as against survivors while median hemoglobin levels were significantly lower (12.12g/dL vs 13.73g/dL). Serum ferritin levels >400ng/mL (Sn 80%, Sp 70%) predicted mortality with high sensitivity and specificity. Notably, serum ferritin levels >400obin, hence should be seen as two sides of the same coin rather than as two discrete entities.

Ferritin-hemoglobin ratio (FHR), which encompasses into a single index, the effects of both elevated levels of ferritin and the severity of anemia, seems to perform particularly well as a prognostic marker and emerged as an independent risk factor for mortality in COVID-19 patients. Hyperferritinemia and anemia, both, are inexorably interlinked in addition to having a role, directly or indirectly in the disease pathophysiology. Ferritin and hemoglobin, hence should be seen as two sides of the same coin rather than as two discrete entities.

Acute onset polyarthritis is a common presentation in rheumatology outpatient consultations, which include both post-infectious arthritis and autoimmune rheumatic diseases (AIRDs). COVID pandemic has added to the list of infectious agents that could result in arthritis.

The retrospective observational study was conducted at a tertiary care centre. The study included patients who presented with clinical suspicion of post-infectious arthritis between July-September 2019 and 2020. The study was extended for another 2 months to include patients who presented between October-November 2020. The patients were categorized into post-viral arthritis, post-COVID arthritis, chikungunya arthritis and AIRDs. The demographics, comorbidities, clinical presentation, examination findings and laboratory parameters and the response to treatment for each participant were collected and assessed.

In the year 2019 and 2020 (July-Sep), the corresponding number of patients analyzed were 20 and 33. The mean duration of presentatis of post-infectious arthritis from AIRDs.

The study revealed that the presence of chikungunya arthritis across the two years was comparable. Post-COVID arthritis needs to be considered as a potential differential in post-infectious arthritis. There are no identifiable characteristics (clinical or a simple routine laboratory parameter) that could differentiate the causes of post-infectious arthritis from AIRDs.

VAP prevention bundle includes daily sedation free interval, DVT prophylaxis, raising head end of bed, use of orogastric rather than nasogastric tube. This study aims to study the practices regarding VAP prevention bundle and its compliance, educating about the practices and effects on patients outcome.

Quasi-experimental study, conducted in 3 phases.

Hospital based.

Invasive Mechanically ventilated patients in the Department of Medicine of a tertiary care hospital. 50 patients included in phase 1 and 3.

Phase 1 and Phase 3 were pre and post intervention phases respectively when compliance to VAP prevention bundle was assessed with intermediate Phase 2, the intervention phase where the residents and nurses were educated about VAP bundle through various means. A checklist was attached to patient records.

Incidence of VAP, total hospital and ICU stay, duration of mechanical ventilation and mortality.

On comparing the 2 phases, it was found that there was increase in the compliance to VAP bundle(p<0.001), use of orogastric tube (p<0.001) and use of daily sedation free interval (p<0.001). Statistically insignificant increase in the use of DVT prophylaxis (p= 0.996) and raising the head end of the bed (p=0.513), and decline in the number of days of ICU(p=0.804) and hospital stay(p=0.907), the duration of mechanical ventilation(p=0.909), mortality(p=0.315) and incidence of VAP(p=0.715) was noted. Among those who developed VAP, there was lower compliance to bundle.

Practices like use of VAP prevention bundle improve on teaching efforts and use of checklist which improves patient care.

Practices like use of VAP prevention bundle improve on teaching efforts and use of checklist which improves patient care.

Candidemia is the fourth common cause of blood stream infection worldwide leading to increased mortality and morbidity. A paradigm shift of Candida albicans to Non-albicans candida (NAC) had led to the increase in resistance to empirically used antifungals. So, an epidemiological study and antifungal susceptibility is essential for meticulous use of antifungals.

To find out the prevalence and antifungal susceptibility of Candida species causing candidemia.

automated blood culture done in BACTEC system followed by its identification and susceptibility testing in VITEK-2 system.

Non-albicans candida was isolated from 73% cases of candidemia. The commonest isolate among neonates and adults were C.krusei and C.tropicalis respectively. C.haemulonii was significantly high among adult population while C.krusei was significantly high among the neonates. 10.4% NAC isolates were resistant to amphotericin B, flucytosine resistance among 37% NAC isolates and among 44% C.albicans isolates, fluconazole resistance was found among 13% and 15% of NAC and C. albicans respectively. Echinocandins were comparatively sensitive to the candida spp.

Non-albicans candida was isolated from 73% cases of candidemia. The commonest isolate among neonates and adults were C.krusei and C.tropicalis respectively. C.haemulonii was significantly high among adult population while C.krusei was significantly high among the neonates. 10.4% NAC isolates were resistant to amphotericin B, flucytosine resistance among 37% NAC isolates and among 44% C.albicans isolates, fluconazole resistance was found among 13% and 15% of NAC and C. albicans respectively. Echinocandins were comparatively sensitive to the candida spp.

COVID-19 patients are categorized as per their clinical severity and their level of care is decided based on the clinical severity. Apart from clinical severity of patients, a need for robust predictors was also felt for early categorization and accurate prediction of final fatal outcome in hospitalized patients.

In this retrospective observational cohort study all the adult patients admitted during November month were included. Available data for epidemiological factors, inflammatory biomarkers and CT severity score were collected and analyzed by univariate and multivariate logistic regression analysis to know predictive ability of each variable. A Receiver operating characteristic analysis was done to compare the predictive ability of each factor for final outcome of death.

We analyzed records of 735 total patients. Most of them were male (72.38%), have a median (IQR) age of 60 years (50-69). Diabetes (42.85%), and hypertension (39.86%) were the most common co-morbidities. After univariate and multivariate regression analysis we could find that CRP, D-Dimer and CT severity score levels only can predict final outcome of death.