Umesh Kumar Ojha

Bio: Umesh Kumar Ojha is an academic researcher. The author has contributed to research in topics: Medicine & Coronavirus disease 2019 (COVID-19). The author has an hindex of 1, co-authored 4 publications receiving 7 citations.

Faciobrachial Myoclonus as the Presenting Manifestation of Diabetic Keto-Acidosis.

Abstract: Background: Chorea and ballism are well-recognized acute potentially reversible movement disorders as the presenting manifestation of non-ketotic hyperglycemic states among older type-2 diabetics. Myoclonus as the form of presentation of diabetic ketoacidosis (DKA) in previously undiagnosed type-1 diabetic has never been reported before. Case report: We herein report the case of a 36-year-old previously healthy patient who presented with acute onset incessant faciobrachial myoclonus for 10 days. The patient was found to be suffering from DKA and eventually diagnosed as type-1 diabetes mellitus. Myoclonus disappeared with achieving euglycemia and did not recur. Discussion: Apart from expanding the spectrum of acute movement disorder among diabetics, this case reiterates the importance of rapid bedside measurement of capillary blood glucose in all patients presenting with acute onset abnormal movements irrespective of their past glycemic status. This simple yet life-saving approach can clinch the diagnosis at the earliest and thus will avoid costly investigations and mismanagement.

“Vaccination saves lives: a real-time study of patients with chronic diseases and severe COVID-19 infection”

Abstract: Abstract Objectives This study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalised COVID-19 adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC). Methods NCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined. Results Analysis of 29,509 hospitalised, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18752 (63.6%)] showed that 15678 (53.1%) had at least one comorbidity. Among 25715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n = 3957). Adjusted odds of dying were significantly higher in age-group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy, and tuberculosis, presenting with dyspnea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6, 7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4, 0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3, 0.7)] were protected from in-hospital mortality. Conclusions WHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality.

An epidemic of iatrogenic Cushing's syndrome in anticipation in post-COVID era

Abstract: Even at the end of first wave of COVID‐19, efficacy and safety of using glucocorticoids were not established.[3,4] Current guidelines recommend steroids in hypoxic COVID‐19 patients to decrease severity and mortality.[5] The World Health Organization recommends dexamethasone up to 6 mg/day (or equivalent dosage of prednisone, methylprednisolone, hydrocortisone) for 5–10 days for hypoxic COVID‐19 patients.[5] A study reveals that there is considerable variation in steroid dose, form, initiation, and stopping criteria among physicians.[6] Contrary to the existing recommendations, majority of them prefer high‐dose methylprednisolone therapy and continue the same beyond 2 weeks. Prescriptions of methylprednisolone 1 g or dexamethasone 24 mg daily are being advised. In many instances, patients are being put on very high dose of intravenous steroid even more than 2 weeks till they get discharged, and further oral steroids prescribed at discharge are being continued for a prolonged period (sometimes over a month).[6,7] Inhalational corticosteroids, approved this year for mild COVID‐19 cases, can also lead to PICS, if used unrestricted.[8] Although still not reported in the context of COVID‐19, posaconazole, a drug approved for mucormycosis, can itself cause Cushing’s syndrome.[9] Tele‐COVID care often fails to determine the exact time and clinical status when steroid should be initiated or stopped, leading to its unregulated use. While corticosteroids have emerged as the holy grails in the management of COVID‐19, over‐the‐counter (OTC) misuse of steroids by lay public is a matter of concern. Unregulated, unrestricted application of steroids by quacks and alternative medical practitioners during this pandemic will likely make the scenario even worse.[10,11] A handful of herbal medicines against COVID‐19 being used by indigenous practitioners contain steroids[11,12] and their misuse will further complicate the scenario.

COVID-19-associated mucormycosis: Evidence-based critical review of an emerging infection burden during the pandemic's second wave in India.

Abstract: Coronavirus Disease 2019 (COVID-19), during the second wave in early 2021, has caused devastating chaos in India. As daily infection rates rise alarmingly, the number of severe cases has increased dramatically. The country has encountered health infrastructure inadequacy and excessive demand for hospital beds, drugs, vaccines, and oxygen. Adding more burden to such a challenging situation, mucormycosis, an invasive fungal infection, has seen a sudden surge in patients with COVID-19. The rhino-orbital-cerebral form is the most common type observed. In particular, approximately three-fourths of them had diabetes as predisposing comorbidity and received corticosteroids to treat COVID-19. Possible mechanisms may involve immune and inflammatory processes. Diabetes, when coupled with COVID-19-induced systemic immune change, tends to cause decreased immunity and an increased risk of secondary infections. Since comprehensive data on this fatal opportunistic infection are evolving against the backdrop of a major pandemic, prevention strategies primarily involve managing comorbid conditions in high-risk groups. The recommended treatment strategies primarily included surgical debridement and antifungal therapy using Amphotericin B and selected azoles. Several India-centric clinical guidelines have emerged to rightly diagnose the infection, characterise the clinical presentation, understand the pathogenesis involved, and track the disease course. Code Mucor is the most comprehensive one, which proposes a simple but reliable staging system for the rhino-orbital-cerebral form. A staging system has recently been proposed, and a dedicated registry has been started. In this critical review, we extensively analyse recent evidence and guidance on COVID-19-associated mucormycosis in India.

Central retinal vein occlusion post-COVID-19 vaccination

Abstract: Coronavirus disease 2019 (COVID-19) is known to cause thromboembolic episodes apart from acute respiratory distress syndrome (ARDS). With large vaccine drives all across the world, there are a few case reports on post-vaccine thrombotic events seen with the AZD1222, ChAdO × 1 vaccine. Here, we present two cases of central retinal vein occlusion presenting immediately after receiving the second dose of the Covishield vaccine. Although the causal relationship cannot be drawn, the ophthalmologist should be aware of this adverse reaction.

Myocardial infarction post COVID-19 vaccine - coincidence, Kounis syndrome or other explanation - time will tell.

Abstract: A case of ST elevation myocardial infarction reported post Coronavirus disease 2019 (COVID-19) vaccine. Probably premature to draw a link between COVID-19 vaccine and myocardial infarction.