Complete Clinical Profile Research Articles

Neutralizing antibody responses to SARS-CoV-2 Omicron variants: Post six months following two-dose & three-dose vaccination of ChAdOx1 nCoV-19 or BBV152.

The Omicron sub-lineages are known to have higher infectivity, immune escape and lower virulence. During December 2022 - January 2023 and March - April 2023, India witnessed increased SARS-CoV-2 infections, mostly due to newer Omicron sub-lineages. With this unprecedented rise in cases, we assessed the neutralization potential of individuals vaccinated with ChAdOx1 nCoV (Covishield) and BBV152 (Covaxin) against emerging Omicron sub-lineages. Neutralizing antibody responses were measured in the sera collected from individuals six months post-two doses (n=88) of Covishield (n=44) or Covaxin (n=44) and post-three doses (n=102) of Covishield (n=46) or Covaxin (n=56) booster dose against prototype B.1 strain, lineages of Omicron; XBB.1, BQ.1, BA.5.2 and BF.7. The sera of individuals collected six months after the two-dose and the three-dose demonstrated neutralizing activity against all variants. The neutralizing antibody (NAbs) level was highest against the prototype B.1 strain, followed by BA5.2 (5-6 fold lower), BF.7 (11-12 fold lower), BQ.1 (12 fold lower) and XBB.1 (18-22 fold lower). Persistence of NAb responses was comparable in individuals with two- and three-dose groups post six months of vaccination. Among the Omicron sub-variants, XBB.1 showed marked neutralization escape, thus pointing towards an eventual immune escape, which may cause more infections. Further, the correlation of study data with complete clinical profile of the participants along with observations for cell-mediated immunity may provide a clear picture for the sustained protection due to three-dose vaccination as well as hybrid immunity against the newer variants.

Clinical profile, management and post operative outcome in patients with anorectal malformations

Background: Anorectal malformations (ARM) form a very important group of anomalies dealt by pediatric surgeons. Identification of different forms of the anomaly, planning investigation and definitive surgical procedure to attain the final goal of a continent child, remains a difficult task till date. Aim of the study was to study complete clinical profile of the ARM patient, surgical procedure and post operative outcome with special emphasis on continence. Methods: We conducted a study at Geetanjali medical college, Udaipur, Rajasthan, India for clinical profile and management of patients with ARM with assessment of post-operative outcome. All cases of ARM operated from August 2016 to June 2021 were included in the study. All aspects of the anomaly i.e., type, age and sex distribution, associated anomalies, surgical technique used and post op complications were assessed. Evaluation of continence was done by Kelly's scoring system. Results: The 71% patients had staged surgery with posterior sagittal ano-rectoplasty (PSARP) being the most common procedure used (71%). Immediate post op complications were nil. Incontinence was present in 29% patients. Constipation was present in 46% patients. On assessing Kelly's scoring 96% patients had satisfactory score. Postoperative continence was achieved in 70.8% and in 83.3% patients after treatment (bowel management). Conclusions: Meticulous planning and surgical technique with sphincter identification and proper placement of ano-rectum are most important to achieve desired results. Kelly's scoring is important to assess post operative results and plan management for incontinence. With aggressive bowel management it is possible to achieve reasonable continence and quality of life for even those anomalies with poor prognosis.

Outcome of Covid-19 Patients Admitted in Emergency Department of Karnali Academy of Health Sciences, Teaching Hospital

Introduction COVID-19, a global health problem, was first identified in the Hubei province, China. While various clinical features of the diseases have been documented, the complete clinical profile is yet to be understood. The purpose of this study is to evaluate the outcome of Covid-19 after admission in the emergency of KAHS during the year 2021January – 2022 January. Methods This is a hospital-based, retrospective, observational study done in the emergency department of Karnali Academy of Health Sciences (KAHS), Jumla. The data was taken from the registry, including the record files of patients with Covid-19 admitted in the hospital from 2020 January to 2021 January. The retrieved data was initially entered in an Excel sheet followed by its analysis. We carried out Kaplan Meier survival distribution analysis to determine the survival probability and predictors of Covid-19. Results Of the 516 Covid-19 positive patients who were admitted in the hospital, 53.5% were males. For the total patients, the mean duration of hospital stay was 8.02±5.32 days with the proportion of patients who died during treatment being 3.7% (n=19). As described by the Kaplan-Meier curve and the accompanying survival table, the mean survival time of the overall patients was 36.74 days (95% CI=35.6–37.8). Moreover, the cumulative survival rate was seen prominently decreased for older patients and those admitted in the intensive care unit and/or ventilator. Conclusion The increased mortality rates seen in the older patients and those admitted in critical care setting clearly calls for the importance of proper and timely intervention.

Combination oral contraceptives – a practice-guided overview of everyday problems and their solutions

Combination oral contraceptives (COCs) are some of the most commonly prescribed drugs for women between the ages of 15–451 and while they are accepted to be safe and highly effective, their use is often associated with a number of minor sideeffects. Considering the limited nature of this review, a detailed overview of the complete clinical profile of COCs falls beyond the current scope. Rather, we will focus on the most frequently reported side-effects of COCs that do not necessitate treatment withdrawal. Adverse effects that require immediate withdrawal of therapy are usually related to deep vein thrombosis (DVT) and other cardiovascular events, malignancies or hepatic pathology2 and would require a more in-depth review.

The blood pressure paradox in acute ischemic stroke.

To explore the association of poststroke baseline blood pressure with cerebral collateral flow and functional outcome in acute ischemic patients with large vessel occlusion/stenosis. Patients identified with large vessel occlusion/stenosis with baseline multimodal computed tomography, follow-up imaging, and complete clinical profiles were included. A 90-day modified Rankin Scale of 0-1 was defined as an excellent functional outcome. Cerebral collateral flow was quantified by the volume ratio of tissue within the delay time >3 seconds perfusion lesion with severely delayed contrast transit (delay time >3 seconds/delay time >6 seconds). There were 306 patients included in this study. With every increase of 10 mmHg in baseline systolic blood pressure, the odds of achieving an excellent functional outcome decreased by 12% in multivariate analysis (odds ratio = 0.88, p = 0.048). Conversely, increased baseline blood pressure was associated with better collateral flow. In subgroup analysis of patients with major reperfusion, higher blood pressure was associated with decreased infarct growth and a better clinical outcome, and vice versa in patients without reperfusion. Higher baseline blood pressure in acute ischemic stroke patients with large vessel occlusion/stenosis was associated with better collateral flow. However, for patients without reperfusion, higher baseline blood pressure was associated with increased infarct growth, leading to an unfavorable clinical outcome. The relationship between blood pressure and outcomes is highly dependent on reperfusion, and active blood pressure-lowering treatment may be inappropriate in acute ischemic stroke patients prior to reperfusion treatment. ANN NEUROL 2019;85:331-339.

Clinical profile of fever in newborn and predictors of outcome

Background: Hyperpyrexia, in neonates is considered as a medical emergency. The aim of the present study was to evaluate complete clinical profile and relevant laboratory investigations in arriving at various etiologies of fever in neonates and to arrive at predictors of mortality among newborns presenting with fever symptoms.Methods: This prospective study conducted in the Neonatology Department of Institute of Child Health and Hospital for Children during the period January 2015 to September 2015. A total of 100 neonates from Day 1 to Day 28 of life regardless of gestational age with fever were included in the study. Complete blood cell counts and blood cultures were obtained on all of the patients.Results: Out of 100 neonates 87% were term new born. Lethargy was the major presenting complaint (48%) associated with fever. Respiratory distress was the most common clinical sign observed in febrile neonates (21%). 63 had a positive septic screening. 16 among those with positive septic screen had an organism grown in the culture. Staphylococcus aureus was the most common organism isolated in febrile neonates. Mortality was seen only in 6% of the neonates who had fever.Conclusion: Children with fever are at higher risk of bacterial infections. They need immediate medical supervision for identification of exact etiology.

Clinical profile and complications of acute malaria caused by different species of Plasmodium

Introduction: Malaria is more severe in children than in adults and 78% of all deaths due to malaria occur in children under 5years. Plasmodium vivax has long been considered to have benign course. However during past few years several studies reported severe complicated cases of vivax malaria. Methodology: Children in the age group of 6 months to 15 years admitted in the Department of Pediatrics with clinical malaria were tested for malaria using peripheral smear, QBC and rapid diagnostic test. Children with positivity of any of these tests were enrolled in the study. Complete clinical profile is noted. Investigations like complete blood counts, LFT, RFT etc., were done. Results: Out of 150 children enrolled in the study 80 had Plasmodium vivax monoinfection. 61 had Plasmodium falciparum monoinfection and 9 had mixed infection. 41% of them were under 5years of age. The incidence of complications like severe anemia (10% vs. 18%), jaundice (10% vs. 44%), transaminitis (6% vs.13%), azotemia (6% vs. 36%) and thrombocytopenia (12.5% vs. 26%) were more common in P falciparum than in P vivax malaria with statistical significance (p < 0.05). There was no statistically significant difference in the incidence of hypoglycemia and cerebral malaria in P vivax and P falciparum malaria. Conclusion: The incidence of severe malaria in P. vivax infection is comparable to that in P. falciparum infection and it is no more benign. Hence robust efforts are required for reduction and elimination of P vivax transmission.

Prognostic Analysis of Patients with Ebola Virus Disease.

BackgroundThe Ebola virus causes an acute, serious illness which is often fatal if untreated. However, factors affecting the survival of the disease remain unclear. Here, we investigated the prognostic factors of Ebola virus disease (EVD) through various statistical models.Methodology/Principal FindingsSixty three laboratory-confirmed EVD patients with relatively complete clinical profiles were included in the study. All the patients were recruited at Jui Government Hospital, Sierra Leone between October 1st, 2014 and January 18th, 2015. We first investigated whether a single clinical presentation would be correlated with the survival of EVD. Log-rank test demonstrated that patients with viral load higher than 106 copies/ml presented significantly shorter survival time than those whose viral load were lower than 106 copies/ml (P = 0.005). Also, using Pearson chi-square test, we identified that chest pain, coma, and viral load (>106 copies/ml) were significantly associated with poor survival of EVD patients. Furthermore, we evaluated the effect of multiple variables on the survival of EVD by Cox proportional hazards model. Interestingly, results revealed that patient’s age, symptom of confusion, and viral load were the significantly associated with the survival of EVD cases (P = 0.017, P = 0.002, and P = 0.027, respectively).Conclusions/SignificanceThese results suggest that age, chest pain, coma, confusion and viral load are associated with the prognosis of EVD, in which viral load could be one of the most important factors for the survival of the disease.

English

BACKGROUND AND OBJECTIVES: To study complete clinical profile of ocular manifestations in haematological disorders METHODS: This was a prospective non-interventional study done on 60 cases admitted and diagnosed with various haematological disorders in Medicine, Paediatrics, Obstetrics and Gynaecology wards. Whenever general condition permitted, patients were examined in more details in the Ophthalmology O.P.D. For the record of visual acuity, a standard Snellen's chart was used. Dilated fundus examination was done in every case. Patients with diabetes, hypertension and dense cataracts were excluded. RESULTS: Out of total 60 cases, 39 cases of anaemia, 13 cases of leukaemia, 4 cases of haemorrhagic disorders and 4 cases of haemoglobinopathies were studied. Conjunctival pallor was observed in all cases (100%) of anaemia and fundal pallor in 38.46 % cases. Retinal haemorrhages were present in 57.14 % cases of megaloblastic anaemia, 50% cases of combined nutritional deficiency anaemia and 60% cases of aplastic anaemia, but absent in iron deficiency anaemia cases. Overall incidence of ocular manifestations in leukaemia was 69.23%. It was higher (87.5 %) in acute leukaemia as compared to chronic leukaemia (40%). Two cases of purpura with associated anaemia showed retinal flame shaped haemorrhages. Thalassemia major cases showed changes like conjunctival pallor and fundal pallor. CONCLUSION: It is essential to examine all patients’ with haematological disorders for ocular manifestations as it helps in diagnosis and prognosis. Early recognition of the ocular manifestations is of great importance as early institution of treatment may prevent or alleviate both ocular and systemic complications.

G.P.5: Clinical profile of a 6-year old boy with Becker Muscular Dystrophy and asymptomatic rhabdomyolysis: A case report

<i>Background:</i> There have been several reports in the literature of exercise-related muscle cramps and myoglobinuria, or asymptomatic myoglobinuria leading to a diagnosis of Becker Muscular Dystrophy (BMD). <i>Objective:</i> To present the complete clinical profile of a child with BMD with asymptomatic rhabdomyolysis, and to contribute to natural history data. <i>Case report:</i> MG is a 6 year old male referred with a dystrophinopathy. He had exercise-induced cramps in his legs and a tendency to toe-walk at age 4. CPK was 8100. He had an Xp21.1 gain-of-function mutation on chromosomal microarray, and an in-frame duplication of exons 17–25 of the dystrophin gene. His initial exam was normal with the exception of mild hypotonia and pronated feet. Muscle MRI of his pelvic and thigh muscles showed minimal fatty changes. Muscle biopsy showed mild dystrophic changes (some increased centrally located nuclei, perimysial fibrosis, minimal necrotic fibers, and minimal fibrofatty changes) with significantly decreased staining for dys3 antibody. Western blot analysis indicated between 20% and 100% of muscle dystrophin confirming BMD. At follow-up, he reported a single episode of dark urine the prior evening which spontaneously resolved, without cramps, pain, or fatigue. Examination was normal. Post-visit labs were notable for rhabdomyolysis (CPK 56 100, AST 930, ALT 675, myoglobin 555). Labs 1week later showed a persistently elevated myoglobin (537), baseline CPK (6182), AST (163), and ALT (332), and normal urinalysis. The patient remained asymptomatic, and was advised to continue aggressive hydration. <i>Conclusion:</i> Our case describes the complete clinical profile (including pathology, dystrophin status, and muscle MR) of a patient with BMD with an episode of asymptomatic rhabdomyolysis. This case highlights the need to appropriately screen children, to provide anticipatory guidance on monitoring and management of rhabdomyolysis to families, and provides natural history data on the disease.

The spectrum of electrocardiographic manifestations of acute myocarditis: An expanded understanding

Background and PurposeDescriptions of the significance of ST segment or QRS abnormalities in myocarditis are limited because documentation of the diagnosis has previously required myocardial biopsy. Late gadolinium enhancement (LGE) and T2 weighted imaging in the midventricular wall on cardiac magnetic resonance imaging (CMRI) has a very good positive predictive value for the diagnosis of myocarditis. We hypothesized to reexplore the diagnostic value of these electrocardiographic (ECG) changes in myocarditis by utilizing CMRI as the reference standard. MethodsData on demographics, clinical presentation, laboratory tests, echocardiograms, coronary angiograms, and computed tomography angiography of 41 consecutive patients with definite midventricular or subepicardial LGE and T2 weighted imaging on CMRI were extracted from the available clinical records. ECGs were blindly examined by two independent readers and divided based on (a) STT changes into: 1. No STT changes, 2. STT changes but no ST elevation, 3. ST elevation (STE); and (b) the presence or absence of QRS abnormalities. Associations of these ECG changes with differences in left ventricular ejection fraction, as measured from CMRI was the main aim of this study. In addition, a complete clinical profile of these patients with myocarditis as identified by CMRI was also created. Results80% of our study population were male with a mean age of 38.6±15.5 and a paucity of traditional cardiovascular risk factors (<30%). 90% presented with chest pain with more than half having dyspnea and a viral prodrome, but fever was infrequent (15%). Peak troponin-I and creatine kinase-MB levels exceeded the upper limit of normal in latest 85%, often by more than 5 times the limit. 18% had a coronary luminal narrowing of ≥50%, while 56% had echocardiographic wall motion abnormalities. The left ventricular ejection fraction averaged 54.3±10.8%. In 24.4% of patients, the ECG was entirely normal; while 39% had STE. STT changes did not detect any differences in the ejection fraction. An abnormal QRS, which was present in 29%, was associated with a lower left ventricular ejection fraction (p=0.005). ConclusionsPatients with clinical features suggestive of myocarditis and confirmatory CMRI findings, can present with a variety of ECG findings, some of which have the potential to identify those with a worse cardiac function, and potentially with a worse prognosis.

200th ENMC International Workshop “European Reference Networks: Recommendations and Criteria in the Neuromuscular field”, 18–20 October 2013, Naarden, the Netherlands

200th ENMC International Workshop “European Reference Networks: Recommendations and Criteria in the Neuromuscular field”, 18–20 October 2013, Naarden, the Netherlands

Updates and Evidence Concerning Concussion in the Physically Active Population

Updates and Evidence Concerning Concussion in the Physically Active Population

Therapeutic targets in ischaemic heart disease.

The adequate treatment of a disease syndrome is dependent upon a clear definition of the symptomatic, pathological, physiological and prognostic targets against which therapy is to be deployed. The syndromes of ischaemic heart disease, including angina pectoris, are complex in origin, pathology, pathophysiology and natural history, and a complete clinical profile is difficult, if not impossible, to achieve in individual patients. The prime goals of pharmacotherapy in ischaemic heart disease are easy to define, but difficult to accomplish in practice. Relief of pain, breathlessness and fatigue are the prime clinical targets for pharmacotherapy. In view of their sinister significance, the electrophysiological indications of myocardial ischaemia, whether symptomatic or silent, are also crucial targets towards which therapy must be directed. Ischaemic heart disease is accompanied by a wide variety of regional and global abnormalities of myocardial contractile function associated with widespread reflex stimulation of the peripheral vascular system and neuroendocrine systems. Primarily, drug therapy must be directed at correction of these pathophysiological components of the syndrome. Longer term but no less essential goals in the treatment of ischaemic heart disease are the prevention of the clinical sequelae of the syndrome and its progression. A natural sequel of coronary artery obstructive disease is successive thrombotic events and loss of myocardium. Calcium antagonists, by preventing the increase in myocardial cytosolic calcium during acute ischaemic episodes, defer cell necrosis; in this respect, they are unique among currently available antianginal drugs. With regard to progression, the prime pathological cause of ischaemic heart disease is coronary atheroma.(ABSTRACT TRUNCATED AT 250 WORDS)