Dhruv Talwar

Background: Vocal cord dysfunction(VCD) may be identified in asthma patients as an important factor contributing to uncontrolled symptoms and escalation of therapy. However, the association of vocal cord dysfunction with pulmonary,extrapulmonary and behavioural traits remains unclear. Objectives: To evaluate associations between VCD score and pulmonary,extrapulmonary and behavioural factors and to examine its relationship with asthma severity. Methods: In this cross-sectional observational study,VCD score was assessed in 200 asthma patients. Associations were analyzed with pulmonary factors (airflow limitation, airway inflammation, infections, dyspnoea),extrapulmonary factors (dysfunctional breathing,daytime sleepiness,mood disorders,systemic inflammation)and behavioral traits (exercise intolerance, sarcopenia, inhaler technique, adherence and polypharmacy). Results: VCD score was not associated with airflow limitation, sputum eosinophilia, serum IgE levels or exercise-induced desaturation. Significantly higher VCD scores were observed in patients with mucus hypersecretion and higher dyspnoea burden (p<0.05). Strong associations were noted with dysfunctional breathing, depression or anxiety. Behavioural factors including exercise intolerance, sarcopenia, inhaler device polypharmacy,inadequate inhaler technique and treatment non-adherence were significantly associated with higher VCD scores. VCD score correlated strongly with the cumulative number of extrapulmonary (ρ=0.68) and behavioural factors (ρ=0.48). Patients with severe asthma had significantly higher VCD scores compared to non-severe asthma(median 27 vs 12, p<0.001). Conclusion: VCD was significantly associated with severity of asthma as well as extrapulmonary and behavoural traits rather than airflow limitation or allergic inflammation

We report the case of a young female suffering from fever and generalized weakness on presentation and was diagnosed to be a case of cryptogenic organizing pneumonia (COP). She developed breathlessness on rest and required oxygen support and on further evaluation diagnosed with Scrub typhus IgM positive status. This case report highlights the importance of a rare presentation of Scrub typhus in a young female presenting with clinically silent chest changes initially and preventable worse outcomes if detected and managed for scrub typhus infection early in the course of disease.

Dengue fever is a prominent challenge in the developing countries throughout the world, with dengue shock syndrome as a leading cause of morbidity and mortality during the seasonal dengue epidemics. Most common presenting features of dengue fever are high grade fever with chills, headache, rash, nausea and vomiting. With the increasing challenges of treating dengue shock syndrome to prevent mortality in the young, it is important to determine factors which can be used to predict dengue shock syndrome. This report showcases a case of 20-year-old young female who presented with the chief complaint of pedal oedema, pain in abdomen along with breathlessness. Upon investigations it was found to be a of dengue fever with pleural effusion and ascites. The patient later developed dengue shock syndrome, which was managed successfully with the help of intravenous fluids, inotropic support and platelet transfusion. Hence, this case report highlights the importance of detection of serositis in the form of ascites, pleural effusion and pedal oedema in dengue fever as a tell-tale sign of upcoming dengue shock syndrome and the pathophysiology behind it.

Hypertensive disorders during pregnancy are an important topic of concern, specifically in rural and remote areas of India where there is a lack of awareness and it is difficult to maintain proper follow-up of pregnant females to screen them for complications developed during pregnancy. Gestational hypertension and pre-eclampsia result in the abruption of the placenta, hemolysis, elevated liver enzymes, low platelet count syndrome, eclampsia, and disseminated intravascular coagulation, which can be a serious threat to the health of the mother and the fetus. Therefore, it is important to identify biomarkers for diagnosing and predicting the complications of pre-eclampsia that may aid the obstetric high-dependency units based in rural areas to tackle this important health hazard during pregnancy. A total of 180 singleton pregnant women of more than 34 weeks of gestational age were enrolled in this study. All women were divided into three groups (control group, severe pre-eclampsia, and non-severe pre-eclampsia) based on the severity of blood pressure and the presence of proteinuria (≥+1 by the dipstick method). Salivary and serum uric acid levels were measured through morning samples, and all patients were monitored for the development of complications and outcomes. Salivary uric acid and serum uric acid levels were correlated with each other and with maternal complications of pre-eclampsia. Mean salivary uric acid (mg/dL) in severe pre-eclampsia was (6.72 ± 0.49) significantly higher compared to non-severe pre-eclampsia (4.75 ± 0.94) and control (3.13 ± 0.43). Mean serum uric acid (mg/dL) in severe pre-eclampsia was (8.13 ± 0.87) significantly higher compared to non-severe pre-eclampsia (6.23 ± 0.76) and control (3.85 ± 0.46).The lowest best cut-off value of maternal salivary uric acid was 5.06 mg/dL, above which one can predict maternal complications with a diagnostic accuracy of 78.33%. Salivary uric acid and serum uric acid levels are significantly raised in cases of pre-eclampsia in comparison to normal pregnancy. Salivary uric acid and serum uric acid are correlated significantly indicating that salivary uric acid can function as a cost-effective, novel marker to provide an idea about serum uric acid levels. The prognostic accuracy of salivary uric acid was good in predicting maternal complications among cases of pre-eclampsia (severe and non-servere) and early-onset maternal complications. Therefore, it may be utilized as a helpful marker to identify high-risk patients.

There is a continual rise in the prevalence of non-cancerous conditions such as chronic kidney disease (CKD) owing to an enormous load of diabetes, hypertension, and vascular diseases. A positive attitude and healthy lifestyle for CKD prevention can only be followed when the masses are well aware and educated about the disease. This study aimed to compare, correlate, and evaluate the distribution of knowledge, attitudes, and perceptions among relatives or caretakers of patients with kidney disease or at risk of the disease. This cross-sectional study aimed at obtaining data on the knowledge, attitudes, and perceptions using the Chronic Kidney Diseases Screening Index questionnaire from the relatives of CKD patients. All data were computed and analyzed using SPSS version 28.0 (IBM Corp., Armonk, NY, USA). The majority of the relatives of CKD patients had poor knowledge (63.6%) and poor attitude (51.6%) levels. On the contrary, most respondents had good practices (52.8%) level toward the risk for CKD. A significant correlation was noted between education and knowledge (p < 0.050). A significant association was also observed between education and occupation with attitude (p < 0.001 and p < 0.050, respectively). Additionally, a significant association was noted between age and perception (p < 0.001). Informed and well-educated populations are less prone to acquire or progress to CKD. From this study, we can understand the need for improvement in public knowledge, which has the potential to help in saving the lives of many patients progressing toward end-stage renal diseases.

Bitemporal hemianopia is the most common visual field defect encountered in suprasellar meningiomas compressing the optic chiasma and its vascular supply. It is hard to distinguish between meningioma and tumors that arise from suprasellar, intrasellar, and infrasellar extensions. Clinical findings, hormonal levels, and radiological findings could help in labeling it as meningioma. A 53-year-old obese woman with a history of blurred vision more in the right eye, loss of smell, and a headache was diagnosed with meningioma having suprasellar, intrasellar, and infrasellar extension on neuroimaging. She developed bitemporal hemianopia, which gradually worsened over the course of six months with concomitant headaches and dizziness that was treated with analgesics leading to a delayed diagnosis. As she was symptomatic, it was decided to resect her tumor. The patient underwent an endoscopic transsphenoidal approach for tumor resection. Successful excision of the tumor was accomplished. Postoperatively on further evaluation, the patient’s anosmia and the visual deficit were resolved. This instance shows that meningioma located in the sella can cause symptoms like anosmia and visual field loss, which should not be neglected. It also underlines the significance of visual field evaluation on a regular basis as this might predict radiological and symptomatic progression.

Pregnancy is considered one of the most delicate conditions for the woman and her fetus, rendering physiological stress on her body. Sometimes, this leads to unwelcomed incidences of certain systemic disorders which further complicate the course of pregnancy. Cardiovascular conditions associated with pregnancy have major morbidity amongst the general population. Peripartum cardiomyopathy, one such condition associated with cardiac dysfunction during pregnancy, is one of the major causes of increased morbidity and mortality in pregnant women. It has been the leading cause of non-obstetric maternal mortality. Due to the stress on the cardiovascular system, further functioning of the body in the milieu gets compromised and thus, the occurrence of fetomaternal mortality is not rare in the prognosis of this condition. Certain studies have noted not only familial but also geographical variations in the prevalence of peripartum cardiomyopathy in certain areas. Although the occurrence of the condition is quite common, there still needs to be a better understanding of this topic for avoiding the abysmal prognosis of this pathology. A peculiar presentation on the electrogram is needed to make an accurate diagnosis of the condition. The therapeutic options of this condition, particularly incline towards medical management. Various new drugs have been formulated and are in clinical trials for testing their effectiveness. Bromocriptine therapy, along with the neoadjuvant combination of anticoagulant drugs and non-pharmacological measures, makes a good treatment regimen that helps avert the progressive pathology. In this article, we discuss the knowledge regarding the etiology, factors contributing to the severity, pathogenesis, treatment options, and the particular outcomes of the therapy.

Acute exacerbation (AE) in idiopathic pulmonary fibrosis (IPF) is unfortunate a deadly event with a very high mortality rate. Its occurrence is highly unpredictable, though few baseline risk factors have been identified. The revised definition of AE is more precise with clarity on defined parameters. However, no clear guidelines exist on treatment, with most therapies showing inconsistent benefits. Both the approved anti-fibrotic (pirfenidone and nintedanib) have shown equal efficacy in reducing the decline in lung functions, with few studies suggesting a drop in AE. We report a case of a patient with IPF with mildly impaired lung functions who was initiated on pirfenidone with dose titrated on a weekly basis but developed AE-IPF on day 10 of starting pirfenidone and after four days of doubling the dose from 600 mg/day to 1,200 mg/day. This raised the suspicion of whether pirfenidone played any role in this unfortunate event. With no response to conventional therapy of steroids and non-invasive ventilation for AE-IPF, initialization of nintedanib led to recovery with discharge of the patient in two weeks of hospitalization. This case highlights inadequacy in knowledge about the effects of these anti-fibrotics in IPF and recommends close monitoring in the future.

Coronavirus disease 2019 (COVID-19)has been a difficult enemy to beat for healthcare professionals around the world. However, even before the end of the COVID-19 pandemic, there has been an emergence of a new combatant in the form of opportunistic fungal infections with a high rate of morbidity and mortality, creating havoc throughout the globe. A case-control single-center study was conducted in Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra. All the subjects who were included in the study were tested positive for COVID-19 through the reverse transcriptase-polymerase chain reaction (RT-PCR) method and the cases were defined as patients with biopsy-proven mucormycosis, whereas control were subjects who did not develop mucormycosis. The duration of the study was three months, from June 2021 to August 2021. A total of 55 cases and 50 controls were enrolled in the study. The use of zinc was found to be significantly associated with COVID-19-associated mucormycosis, with 89.1% of the cases having a history of zinc intake and only 52% of controls having a history of zinc intake( p-value <0.001). Diabetes mellitus was found to be significantly associated with COVID-19-associated mucormycosis with 83.6% of the cases and 16% of the controls having diabetes mellitus (p-value <0.001). Although the use of steroids in cases was more with 98.2% of the cases and 54% of the control receiving steroids; this difference was not significant statistically (p-value of 1.00). We conclude that apart from diabetes mellitus and other immunosuppressive states, zinc might be the hidden culprit behind the sudden surge of COVID-19-associated mucormycosis worldwide owing to the self-administration of zinc by the patients to acquire innate immunity and over-prescription of multivitamins by the treating clinicians. However, this association required further studies in order to be proved.

We report a young female having severe pallor and breathlessness on presentation, being diagnosed as a case of megaloblastic anemia, which was confirmed on bone marrow biopsy. On detailed history taking, she was revealed to have anorexia nervosa precipitated due to extreme fear of COVID-19 along with obsessive-compulsive disorder. Thus, a psychiatric disorder presenting due to simple phobia of COVID-19 can also have a fatal outcome in the young. Therefore, psychiatric health needs urgent attention by physicians, governments, and policymakers across the globe to prevent the surge of mental illness during the ongoing pandemic.