Showing papers by "Prashant P. Joshi published in 2023"
TL;DR: In this paper , the authors evaluated the post discharge symptoms in hospitalized mild and moderate COVID-19 patients during the initial phase of pandemic and determined factors associated with post-COVID symptoms and delayed recovery times.
Abstract: Settings and Design: Retrospective online cross-sectional analytical study. Introduction: Infection with SARS-CoV-2 virus led to COVID-19 pandemic with varied clinical manifestations and multisystem involvement, which persisted beyond acute stage. To evaluate the post discharge symptoms in hospitalized mild and moderate COVID-19 patients during the initial phase of pandemic. Factors associated with post-COVID symptoms and delayed recovery times were determined. Materials and Methods: One hundred and thirty-two hospitalized patients of mild or moderate COVID-19 infection diagnosed by a positive real-time polymerase chain reaction, responded to an online questionnaire. They were followed up monthly, telephonically for post-COVID symptoms and recovery times. Microsoft Excel-Student's t-test, Fischer's exact test, Chi-square test. Results: The mean age of the patients was 51.14 ± 13.78 years with male: female ratio, 1: 0.29. 80.35% had post-acute COVID symptoms. Most frequent symptoms were cough in 37.9%, breathlessness in 36.4% and fatigue in 34.8%. New onset symptoms were insomnia in 16.67%, anxiety in10.6%, depression in 9.8%, loss of libido in 5.3%. Long COVID syndrome occurred in four patients. The factors significantly associated with post-COVID symptoms were older age, comorbidities, longer hospitalization, and moderate COVID infection, whereas delayed recovery times were associated with older age, female gender, and moderate COVID illness. Conclusions: Post-COVID symptoms occur in majority of the patients. Persistent symptoms are dry cough, dyspnea, fatigue, anosmia, and ageusia. They are significantly associated with older age, underlying comorbidities, prolonged hospitalization, and moderate COVID infection. Complete recovery occurs in most patients but delayed recovery is seen in females, elderly, and moderate COVID infection. Few may develop long COVID syndrome. The following core competencies are addressed in this article: Patient care and procedural skills, Medical knowledge.
TL;DR: In this paper , a prospective cohort study was carried out in selected tertiary care teaching medical institutes of Central India to evaluate the association between Vitamin D and the disease severity and mortality in COVID-19.
Abstract: Background: Many factors have been proposed to be associated with the severity of disease and mortality in COVID-19. Vitamin D had recently been reviewed as one of these factors. Aim and Objectives: To evaluate the association between Vitamin D and the disease severity and mortality in COVID-19. Materials and Methods: After approval from Institutional Ethics Committee, this prospective cohort study was carried out in selected tertiary care teaching medical institutes of Central India. Participants were COVID-19 patients of the age group of 18 years and above admitted during the study period. They were categorized into four groups as asymptomatic (Group A), mild (Group B), moderate (Group C), and severe (Group D) based on clinical symptoms, respiratory rate, oxygen saturation, and chest imaging. Serum level of Vitamin 25(OH) D was measured using chemiluminescent immunoassay. The outcome of the disease was classified as recovery and death during hospitalization. The association of sociodemographic and medical characteristics with treatment outcome was studied using an appropriate statistical test. A full logistic regression model was built for the assessment of the relationship between treatment outcomes with Vitamin D level. Further, one receiver operating characteristic curve was developed to examine the prognostic significance of Vitamin D levels in COVID-19 patients. Results: Out of 748 enrolled patients, 44 (5.88%), had severe disease (Group D). A total of 721 cases (96.39%) recovered and were discharged, whereas 27 (3.61%) died during hospitalization. Mean Vitamin D level was found to be significantly different in discharged patients compared to those who were deceased. Increasing age-adjusted odds ratio (AOR) (95% confidence interval [CI]=1.07 [1.02–1.12]), known hypertension AOR (95%CI) = 3.38 (1.13–10.08), and diabetes mellitus AOR (95%CI) =28.5 (6.04–134.13) were found to be significant predictors of death among COVID-19 patients. Increasing Vitamin D level was found to be protective against COVID-19-related death (AOR (95% CI = 0.87 [0.80–0.94]). Conclusion: Vitamin D was significantly associated with the disease severity and mortality in COVID-19.
TL;DR: In this article , the performance of Madras Diabetes Research Foundation (MDRF)-Indian Diabetes Risk Score (IDRS) to screen for undiagnosed type 2 diabetes in a large representative population in India was evaluated.
Abstract: Background & objectives: Screening of individuals for early detection and identification of undiagnosed diabetes can help in reducing the burden of diabetic complications. This study aimed to evaluate the performance of Madras Diabetes Research Foundation (MDRF)-Indian Diabetes Risk Score (IDRS) to screen for undiagnosed type 2 diabetes in a large representative population in India. Methods: Data were acquired from the Indian Council of Medical Research–INdia DIABetes (ICMR–INDIAB) study, a large national survey that included both urban and rural populations from 30 states/union territories in India. Stratified multistage design was followed to obtain a sample of 113,043 individuals (94.2% response rate). MDRF-IDRS used four simple parameters, viz. age, waist circumference, family history of diabetes and physical activity to detect undiagnosed diabetes. Receiver operating characteristic (ROC) with area under the curve (AUC) was used to assess the performance of MDRF-IDRS. Results: We identified that 32.4, 52.7 and 14.9 per cent of the general population were under high-, moderate- and low-risk category of diabetes. Among the newly diagnosed individuals with diabetes [diagnosed by oral glucose tolerance test (OGTT)], 60.2, 35.9 and 3.9 per cent were identified under high-, moderate- and low-risk categories of IDRS. The ROC-AUC for the identification of diabetes was 0.697 (95% confidence interval: 0.684-0.709) for urban population and 0.694 (0.684-0.704) for rural, as well as 0.693 (0.682-0.705) for males and 0.707 (0.697-0.718) for females. MDRF-IDRS performed well when the population were sub-categorized by state or by regions. Interpretation & conclusions: Performance of MDRF-IDRS is evaluated across the nation and is found to be suitable for easy and effective screening of diabetes in Asian Indians.
[...]
TL;DR: The case of a 62-year-old man who presented at the hospital with a painless pulsatile swelling in the left breast was diagnosed to be a pseudoaneurysm of the left ventricle with subcutaneous herniation, which is extremely rare.
Abstract: M. Sanj.eva Rao, MS Prashant Vaijyanath, MCh Karuna Taneja, MD Bharat Duboy, MS Subhash C. Manchanda, MD, DM P. Venugopal, MCh Pseudoaneurysm of the left ventricle is rare, and recurrence is extremely rare. We report the case of a 62-year-old man who presented at our hospital with a painless pulsatile swelling in the left breast. He had undergone coronary artery bypass grafting and left-ventricular aneurysmectomy 14 years earlier. On investigation, the swelling was diagnosed to be a pseudoaneurysm of the left ventricle with subcutaneous herniation. The extreme rarity of this condition prompted us to report the case. The investigative techniques and the surgical strategy are discussed. (Tex Heart Inst J 1998;25:309-11)
TL;DR: A 46-year-old female patient presented with severe anemia, cough, and breathlessness, and was diagnosed with cold agglutinin disease, a type of autoimmune hemolytic anemia (AIHA) as discussed by the authors .
Abstract: Mixed connective tissue disease (MCTD) is an overlap syndrome characterized by features of systemic lupus erythematosus, scleroderma, and polymyositis, along with the presence of the U1RNP antibody. A 46-year-old female patient presented with severe anemia, cough, and breathlessness, and was diagnosed with cold agglutinin disease, a type of autoimmune hemolytic anemia (AIHA). Autoimmune workup revealed MCTD by positive antinuclear and U1RNP antibodies. She had bilateral miliary mottling on X-ray and a tree-in-bud appearance on high-resolution computed tomography of the thorax, which were suggestive of pulmonary tuberculosis. Standard therapy with steroids was not advisable. She was subsequently started on anti-tuberculosis treatment (anti-Koch's therapy), followed by steroid therapy and immunosuppressive therapy after three weeks. The patient responded well to treatment, but after two months, she developed cytomegalovirus (CMV) retinitis. Adult-onset CMV disease may occur as a result of primary infection, reinfection, or activation of a latent infection. Although not directly related, it can occur as an atypical association in the setting of immunosuppressive therapy. Morbidity and mortality are significantly increased in this population secondary to infectious potentiation: immunosuppression causes infections, and infections cause AIHA. The management of MCTD and secondary AIHA and immunosuppression poses a therapeutic challenge.