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Showing papers by "Mahatma Gandhi Memorial Medical College published in 2021"


Journal ArticleDOI
07 Sep 2021-Viruses
TL;DR: In this article, the authors collected 677 clinical samples (throat swab/nasal swabs) of individuals from 17 states/Union Territories of the country who had received two doses (n = 592) and one dose(n = 85) of vaccines and tested positive for COVID-19.
Abstract: From March to June 2021, India experienced a deadly second wave of COVID-19, with an increased number of post-vaccination breakthrough infections reported across the country. To understand the possible reason for these breakthroughs, we collected 677 clinical samples (throat swab/nasal swabs) of individuals from 17 states/Union Territories of the country who had received two doses (n = 592) and one dose (n = 85) of vaccines and tested positive for COVID-19. These cases were telephonically interviewed and clinical data were analyzed. A total of 511 SARS-CoV-2 genomes were recovered with genome coverage of higher than 98% from both groups. Analysis of both groups determined that 86.69% (n = 443) of them belonged to the Delta variant, along with Alpha, Kappa, Delta AY.1, and Delta AY.2. The Delta variant clustered into four distinct sub-lineages. Sub-lineage I had mutations in ORF1ab A1306S, P2046L, P2287S, V2930L, T3255I, T3446A, G5063S, P5401L, and A6319V, and in N G215C; Sub-lineage II had mutations in ORF1ab P309L, A3209V, V3718A, G5063S, P5401L, and ORF7a L116F; Sub-lineage III had mutations in ORF1ab A3209V, V3718A, T3750I, G5063S, and P5401L and in spike A222V; Sub-lineage IV had mutations in ORF1ab P309L, D2980N, and F3138S and spike K77T. This study indicates that majority of the breakthrough COVID-19 clinical cases were infected with the Delta variant, and only 9.8% cases required hospitalization, while fatality was observed in only 0.4% cases. This clearly suggests that the vaccination does provide reduction in hospital admission and mortality.

57 citations


Posted ContentDOI
15 Jul 2021-medRxiv
TL;DR: In this paper, the authors collected 677 clinical samples (throat swab/ nasal swabs) of individuals who had received two doses (n=592) and one dose (n =85) of vaccines (Covishield and Covaxin) and tested positive for COVID-19, from 17 states/Union Territories of India.
Abstract: During March to June 2021 India has experienced a deadly second wave of COVID-19 with an increased number of post-vaccination breakthrough infections reported across the country. To understand the possible reason of these breakthroughs we collected 677 clinical samples (throat swab/ nasal swabs) of individuals who had received two doses (n=592) and one dose (n=85) of vaccines (Covishield and Covaxin,) and tested positive for COVID-19, from 17 states/Union Territories of country. These cases were telephonically interviewed and clinical data was analyzed. A total of 511 SARS-CoV-2 genomes were recovered with genome coverage of higher than 98% from both the cases. Analysis of both the cases determined that 86.69% (n=443) of them belonged to the Delta variant along with Alpha, Kappa, Delta AY.1 and Delta AY.2. The Delta variant clustered into 4 distinct sub-lineages. Sub-lineage–I had mutations: ORF1ab-A1306S, P2046L, P2287S, V2930L, T3255I, T3446A, G5063S, P5401L, A6319V and N-G215C; Sub-lineage –II : ORF1ab- P309L, A3209V, V3718A, G5063S, P5401L and ORF7a-L116F; Sub-lineage –III : ORF1ab- A3209V, V3718A, T3750I, G5063S, P5401L and Spike-A222V; Sub-lineage –IV ORF1ab- P309L, D2980N, F3138S and spike - K77T. This study indicated that majority of the clinical cases in the breakthrough were infected with the Delta variant and only 9.8% cases required hospitalization while fatality was observed in only 0.4% cases. This clearly suggests that the vaccination does provide reduction in hospital admission and mortality.

24 citations


Journal ArticleDOI
04 Oct 2021-BMJ Open
TL;DR: In this article, the authors analyzed the factors associated with mortality in a cohort of moderately and severely ill patients with COVID-19 enrolled in a randomised trial on convalescent plasma.
Abstract: Objective Large data on the clinical characteristics and outcome of COVID-19 in the Indian population are scarce. We analysed the factors associated with mortality in a cohort of moderately and severely ill patients with COVID-19 enrolled in a randomised trial on convalescent plasma. Design Secondary analysis of data from a Phase II, Open Label, Randomized Controlled Trial to Assess the Safety and Efficacy of Convalescent Plasma to Limit COVID-19 Associated Complications in Moderate Disease. Setting 39 public and private hospitals across India during the study period from 22 April to 14 July 2020. Participants Of the 464 patients recruited, two were lost to follow-up, nine withdrew consent and two patients did not receive the intervention after randomisation. The cohort of 451 participants with known outcome at 28 days was analysed. Primary outcome measure Factors associated with all-cause mortality at 28 days after enrolment. Results The mean (SD) age was 51±12.4 years; 76.7% were males. Admission Sequential Organ Failure Assessment score was 2.4±1.1. Non-invasive ventilation, invasive ventilation and vasopressor therapy were required in 98.9%, 8.4% and 4.0%, respectively. The 28-day mortality was 14.4%. Median time from symptom onset to hospital admission was similar in survivors (4 days; IQR 3–7) and non-survivors (4 days; IQR 3–6). Patients with two or more comorbidities had 2.25 (95% CI 1.18 to 4.29, p=0.014) times risk of death. When compared with survivors, admission interleukin-6 levels were higher (p 10 (9.97, 3.65–27.13, p 1.0 mg/L (2.50, 1.14–5.48, p=0.022), ferritin ≥500 ng/mL (2.67, 1.44–4.96, p=0.002) and lactate dehydrogenase ≥450 IU/L (2.96, 1.60–5.45, p=0.001) were significantly associated with death. Conclusion In this cohort of moderately and severely ill patients with COVID-19, severity of illness, underlying comorbidities and elevated levels of inflammatory markers were significantly associated with death. Trial registration number CTRI/2020/04/024775.

12 citations


Journal ArticleDOI
TL;DR: In this paper, the authors have discussed the need of integrating TB and COVID-19 to augment India's health outreach to diminish the effect of the COVID19 crisis on TB.
Abstract: India is home to the most significant number of tuberculosis (TB) cases around the globe. The COVID-19 crisis has deeply perturbed most of the essential TB services in India. Regulating TB is difficult in a densely populated country like India due to latent TB infection in millions of Indians, which can reactivate at any point in the future. Due to the ongoing pandemic, healthcare workers have been diverted to activities implemented for effective COVID-19 management, leaving a meager workforce to help deal with TB management. Integrating TB and COVID-19 to augment India's health outreach is the need of the hour to diminish the effect of the COVID-19 crisis on TB. Increasing overall testing capacity, active screening, implementation of strategies for easy identification of TB hotspots, and ensuring uninterrupted drug supply for treatment through heedful planning of local and regional distribution and transportation will especially help cater to the vulnerable population who are at a high risk of suffering from adverse outcomes of TB. Lessons learnt in the battle against COVID-19 can most definitely help in providing insights to fulfill the goal of eliminating TB from India.

11 citations


Journal ArticleDOI
TL;DR: Author’s “SIREN” reaction plan is for first responders, and a burn management guideline for primary healthcare level with an acronym “ALERT-DAY” protocol to decrease morbidity of burn.
Abstract: Burn injuries are not uncommon, and a decade ago, more than one subject with major burn injury arrived in our emergency department each day. We here report of some basic epidemiological data of burn injury for a period of 11 years and propose an approach for prevention and care of burn. Authors obtained the records of the 5500 patients admitted in tertiary care unit of central India from March 2005 to March 2016. The preclinical, clinical, and stage of resolution variables are included in the customized proforma. Few additional data was available in the case sheets of year 2016 and analyzed separately. Data are analyzed using Statistical Package for the Social Sciences. The mean age was 28.6 years with standard deviation of 13.26. Male to female ratio was 1:1.36. Frequency from neighboring district (51.81%), Hindus (86.83%), accidental intent of burn (85.2%), flame type of injuries (76.45%), kerosene as agent of burn (69.4%), home as place of burn (90.92%) are other recognizable variables. Clinical and outcome variables are total body surface area (> 50%) in 57%, hospital stay (> 3 days) in 61.5%, mortality rate (46%), left against medical advice (LAMA) in 36.4%, and survival rate (15.4%). In a select group of 500 patients, some other useful variables like careless attitude in handling kerosene (84%), illiteracy (74.2%), low socioeconomic status (83.4%), married status (75.8%), and family size (> 3) in 74.8% were recorded. In India, burns are preventable by elimination of kerosene/distribution in closed containers. Community-based prevention program is a must. Author’s “SIREN” reaction plan is for first responders. Authors prepared a burn management guideline for primary healthcare level with an acronym “ALERT-DAY” protocol to decrease morbidity of burn. Upgradation of existing burn center is essential to curb the mortality and LAMA rates and improve the survival.

2 citations


Journal ArticleDOI
18 Jun 2021-Cureus
TL;DR: In this paper, the authors reviewed the surgical outcomes of 35 patients who underwent excision of intradural extramedullary (IDEM) spinal cord tumors and found that 77.14% of patients had good functional outcomes as per improvement in Frankel score.
Abstract: Introduction Intradural extramedullary (IDEM) spinal cord tumors account for approximately two-thirds of largely benign intraspinal neoplasms. These are amenable to gross total excision and usually carry a good functional outcome. Methods In this study, we reviewed the surgical outcomes of 35 patients who underwent excision of intradural extramedullary tumors. Patient demographics, severity and duration of symptoms, and tumor characteristics (anatomical and pathological) in all operated spinal IDEM tumors were collected. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel and Nurick grading. The back pain was assessed with help of the Denis pain scale (DPS). Results The histopathological outcomes of the study were as follows: six patients of neurofibroma, 12 cases of schwannoma, nine cases of meningiomas, three cases of ependymoma, one case of dorsal neurenteric cyst, two cases of epidermoid cyst, one case of cauda equina paraganglioma, and one case of filum terminale dermoid cyst. Paresthesia/numbness were the commonest symptoms (88.6%), weakness of limbs in (80%), sphincter dysfunction in 15 patients (42.9%), and paraplegia was seen in three patients (8.57%). The complications encountered were - one case each of cerebrospinal fluid (CSF) leak, surgical site infection, and pseudomeningocele. The percentage of spinal canal occupied ranged from 71-94%. The mean percentage of the spinal canal occupied by the tumor was 81.8%. In our series, 77.14% of patients (p<0.0001) had good functional outcomes as per improvement in Frankel score. The DPS and Nurick score mean values showed a significant decrease over the follow-up duration as compared to preoperative mean values. Significant functional improvement was noted at the one-week, one-month, and one-year follow-up, with a p-value of <0.0001. Conclusions The IDEM tumors are usually benign and are readily detected by contrast-enhanced MRI scans. These have excellent surgical outcomes with some exceptions. Greater canal occupancy and a longer duration of symptoms are usually seen to correspond with suboptimal functional outcomes.

2 citations


Journal ArticleDOI
11 Jun 2021-Cureus
TL;DR: The most prevalent comorbid SUD among suicidal inpatients was cannabis (15.3%) but had a statistically non-significant association with suicidal behaviors (OR 0.98; 95% CI 0.95-0.99) compared to other SUD.
Abstract: Objectives To determine the demographic predictors of suicidal behaviors and measure the association between the spectrum of substance use disorders (SUD) and hospitalization for suicidal behaviors in the adolescent population. Methods We conducted a cross-sectional study using the nationwide inpatient sample and included 466,244 adolescent inpatients with psychiatric illnesses. The study sample was sub-grouped into suicidal (N = 182,454) and non-suicidal (N = 283,790) cohorts. The odds ratio (OR) of association for demographic characteristics and comorbid SUD in the suicidal group was evaluated using a logistic regression model witha P-value < 0.01. Results Our study population included 466,244 adolescent inpatients. Females had higher odds of suicidal behaviors (OR 1.45; 95% CI 1.431-1.470) compared to males. The most prevalent comorbid SUD among suicidal inpatients was cannabis (15.3%) but had a statistically non-significant association with suicidal behaviors (OR 0.98; 95% CI 0.95-0.99). Inpatients with alcohol use disorders had significantly increased odds of association with suicidal behaviors (OR 1.18; CI: 1.142-1.209) compare to other SUD. Among other substances (cannabis and stimulants), there existed a statistically non-significant association with hospitalization for suicidal behaviors. Conclusion Adolescent inpatients with comorbid alcohol use disorders were at 18% higher odds of hospitalization for suicidal behaviors. Our study provides a basis for more research while also suggesting potential avenues for early identification and intervention efforts for comorbid SUD in adolescents requiring psychiatric care to improve their prognosis and quality of life.

2 citations


Journal ArticleDOI
15 Feb 2021-Cureus
TL;DR: A case report of a 25-year-old male who believed himself to be transformed into a buffalo after bestiality along with developing obsessive-compulsive features is discussed in this paper.
Abstract: Lycanthropy is a rare variant of a delusional misidentification syndrome specifically reverse inter-metamorphosis where patients believe that they are experiencing transformation or have transformed into an animal. A case report of this phenomenon is discussed. We report the lycanthropy phenomenon of a 25-year-old male who believed himself to be transformed into a buffalo after bestiality along with developing obsessive-compulsive features. A case report along with a literature review forms the basis of discussion. Clinical lycanthropy has been reported with various neuropsychiatric conditions including primary psychotic and affective conditions, drug intoxication and withdrawal, cerebrovascular disease, traumatic brain injury, dementia, delirium, and seizures, but its association in the context of obsessive-compulsive and related disorders (OCRDs) is a very rare finding. A differential of OCRD should be given due importance and managed accordingly when dealing with lycanthropy, which may help in early identification and management.

1 citations


Journal ArticleDOI
TL;DR: A two-year-old boy was referred for intermittent frontal headache that arose after falling from his own height the day before, with phonophobia, photophobia and triggered by exertion/defecation, and associated with a single postprandial vomiting.
Abstract: Arachnoid cysts are benign congenital extra-axial malformations filled with cerebrospinal fluid, but not communicating with the ventricular system. Most are asymptomatic, usually found incidentally in neuroimaging studies. A two-year-old boy was referred for intermittent frontal headache that arose after falling from his own height the day before, with phonophobia, photophobia and triggered by exertion/defecation, and associated with a single postprandial vomiting. There were no visual complaints and no focal deficits on neurological examination. Neuroimaging studies revealed a left frontotemporal cystic lesion of 82 mm × 52 mm × 77 mm, compressing insula and adjacent structures, and a bilateral subdural hygroma of probable posttraumatic etiology. He remained in hospital surveillance, maintaining hemodynamic stability and progressive clinical improvement; thereupon he was discharged and forwarded to Neurosurgery Consultation. Despite conventional neurosurgical treatment recommendation, newer reports suggest a promising role for the conservative approach, even in voluminous symptomatic lesions. This clinical case comes to corroborate the most recent evidence.

1 citations


Journal ArticleDOI
Abstract: Type 1 interferons, especially interferon-beta, has been reported to be effective in COVID-19 patients in multiple randomized controlled trials. The aim of our meta-analysis and systematic review is to assess efficacy of subcutaneous IFN-beta in regards to mortality and discharge rate. Prospective, retrospective and randomized controlled trials were included. Primary outcomes measured were 28-day mortality and discharge rate. Secondary outcomes measured were mean hospital stay and post-intervention intubation rate. A thorough literature search was conducted in Medline, PubMed, Ovid journals, Google Scholar, and Cochrane Central Register of Controlled Trials & Database of Systematic Reviews from 1 April 2020 to 28 February 2021. Relative risk was calculated using both the Mantel-Haenszel method (fixed-effects model) and DerSimonian Laird method (random effects model). The heterogeneity among studies was tested using Cochran's Q test, based upon inverse variance weights. 7 studies were included in the meta-analysis and systematic review. The IFN-beta group did not improve the 28-day mortality (RR = 1.276; 95% CI: 1.106-1.472, p = 0.001) or the discharge rate (RR = 0.906; 95% CI = 0.85-0.95, p = < 0.001). The mean hospital stay was 11.95± 2.5 days in the interferon-beta group and 11.43 ± 3.74 days in the traditional treatment group. Likewise, interferon-beta did not add any advantage to post-intervention intubation rate (RR = 0.92; 95% CI = 0.7841-1.0816, p = 0.3154). Our findings revealed that use of subcutaneous interferon-beta is futile in COVID-19.

1 citations


Book ChapterDOI
01 Jan 2021
TL;DR: In this article, the pathophysiology, molecular mechanism, and physiological as well as anatomical considerations that lead to variceal development and mechanisms of variceAL bleeding are discussed.
Abstract: Variceal formation and bleeding from varices are the endpoint of a series of pathophysiological events that occur in patients with cirrhosis who develop clinically significant portal hypertension. Through decades of animal model and human studies, the pathomechanisms that lead to the formation of varices and bleeding have been delineated with progressive clarity. This understanding has led to improvements in medical and interventional management of portal hypertensive events, which has eventually increased survival in patients with cirrhosis. In this chapter, we discuss the pertinent pathophysiology, molecular mechanism, and physiological as well as anatomical considerations that lead to variceal development and mechanisms of variceal bleeding.

Journal ArticleDOI
09 Aug 2021-Cureus
TL;DR: In this paper, a 15-year-old male patient described a strange experience where he found himself to be floating outside his own body while he visualized his self body from a third-person perspective.
Abstract: Out-of-body experiences (OBEs) are hallucinatory visual experiences that involve seeing the physical body placed in an external visual space. Many psychiatric disorders, brain dysfunctions, pharmacological agents, and altered psychological states are reportedly associated with these phenomena. OBEs have been linked to various brain lesions, particularly in the parietal and temporal regions, psychiatric disorders, severe emotional states like a near-death experience, substance use, migraine, and epilepsy, but very few have been reported in dissociative identity disorder. In this report, we present the case of a 15-year-old male patient who described a strange experience where he found himself to be floating outside his own body while he visualized his own body from a third-person perspective. On further evaluation, a diagnosis of dissociative identity disorder and dissociative fugue was formulated. The patient showed improvement after undergoing abreaction, hypnosis, and relaxation training along with supportive psychotherapy. Dissociative disorders occur due to an internal conflict between ego and self, when a person is unable to successfully repress a traumatic experience, or when a repressed memory or experience comes out of the cocooned barrier, leading to an altered state of perception and self-experience, which is described by the patient as OBE. This report presents a scarce differential in the context of psychiatric illness, which might be helpful in the formulation of approaches toward management in cases of such OBE, making it a strange yet intriguing addition to the literature.


Journal ArticleDOI
TL;DR: The current study concludes the importance of myocardial infarction in presence of prognostic inflammatory markers: higher IL-6 and plasma fibrinogen level, instead of highsensitivity C-reactive protein, incase and control groups.
Abstract: Aims: This study was done to find out retrospective case-control with respect to myocardial infarction diagnosis on the basis of biochemical markers and lipid profile characteristics. Design and Setting: This study was conducted at the Department of Biochemistry and sample collection at LPS Institute of Cardiology & Cardiac Surgery Department, Kanpur. Methods: The total number of subjects participated in this study (n=178), of either sex (with age>65years) were included in this study from the case collected from Outpatient Department (OPD) and Indoor Patient Department (IPD) and control from patients attendant, which consisted of two subject groups: The group I: myocardial infarction (cases) n= 89 and Group II: Healthy Subjects (controls) n= 89. Laboratory methodology was performed to determine the prime important risk factors such as body mass index (BMI), blood pressure and lipid profile characteristics associated with myocardial infarction. Risk factors were analyzed by Chi-square and Pearson correlation, receiver operating characteristic (ROC) curve method considered significant when the critical, P <0.01level was set up, for a 95% confidence interval. Results: Total number of (n=178) participants (males=65; mean age of 65 years, females=24, mean age of 58 years) at 95% CI were considered in this study, out of these, 89 individuals were expected to have risk of myocardial infarction (especially observed in case groups), and remaining 89 individuals were considered as control groups, all were included as, study subjects. Conclusion: The current study concludes the importance of myocardial infarction in presence of prognostic inflammatory markers: higher IL-6 and plasma fibrinogen level, instead of high-sensitivity C-reactive protein, incase and control groups.

Journal ArticleDOI
08 Jul 2021-Cureus
TL;DR: In this article, the differences in demographic characteristics and hospitalization outcomes including the severity of illness, hospitalization length of stay (LOS) and cost, utilization of deep brain stimulation (DBS), and disposition in Parkinson's disease (PD) inpatients with psychiatric comorbidities versus without psychiatric comorrbidities were delineated.
Abstract: Objectives We aim to delineate the differences in demographic characteristics and hospitalization outcomes including the severity of illness, hospitalization length of stay (LOS) and cost, utilization of deep brain stimulation (DBS), and disposition in Parkinson’s disease (PD) inpatients with psychiatric comorbidities versus without psychiatric comorbidities. Methods We conducted a cross-sectional study using the Nationwide Inpatient Sample (NIS), included 56,844 PD inpatients (age ≥40 years), and subdivided them by inpatients into those without psychiatric comorbidities (N = 38,629) and with psychiatric comorbidities (N = 18,471). We compared the distributions of demographic characteristics and hospitalization outcomes (severity of illness, utilization ofDBS, and disposition) by performing Pearson’s chi-square test, and we measured the differences in continuous variables (i.e., age, LOS, and cost) by using the independent samples t-test. Results A significantly higher proportion of PD inpatients with psychiatric comorbidities were female (44.4%) and white (83%) and had a moderate loss of functioning (48.8%) compared to those without psychiatric comorbidities. PD inpatients with psychiatric comorbidities had an increased mean LOS (4.7 days vs. 3.7 days, P <0.001) but a lower mean cost ($37,445 vs. $ 41,957, P <0.001). Also, there was a significantly lower utilization of DBS in PD inpatients with psychiatric comorbidities (19.2% vs. 26.9%, P <0.001) compared to those without psychiatric comorbidities, and an adverse disposition of transfer to a skilled nursing facility/intermediate care facility (47.1% vs. 39.6%, P <0.001) compared to PD inpatients without psychiatric comorbidities. Conclusion Although PD patients with psychiatric comorbidities had a moderate loss of functioning, there was significant underutilization of DBS. Meanwhile, psychiatric comorbidities among PD patients led to increased LOS and transfer to skilled facilities.

Journal ArticleDOI
TL;DR: Antibiotic prescription by health care providers, especially AYUSH doctors, needs to be restricted given the high number of antibiotics per prescription, which will limit the indiscriminate use of antibiotics and may be a big step towards achieving the antibiotic stewardship goal.
Abstract: Objectives: To audit the patterns and quality of antibiotic prescription for children in the outpatient department (OPD). Methods: This prospective observational study was conducted on the tertiary care outpatient department of a teaching hospital. One thousand prescriptions for children between 1 month and 15 years of age, who attended the outpatient department of a tertiary care teaching hospital between April 2018 and May 2019, were included. The quality of prescriptions was assessed based on 12 pretest parameters. One score was given to each correctly written parameter, and total scores were categorized as poor (0 - 4), average (5 - 8), and good (9 - 12). The core prescribing indicators presented by the world health organization (WHO) were used to analyze antibiotic prescribing patterns. The data were analyzed using open-source Epidata software. Results: Out of 1000 prescriptions, quality was average in 490 (49%) and poor in 46 (4.6%) prescriptions. The average number of medicines prescribed per encounter was 3.5 (reference value < 2). The medicines were prescribed by their generic names in 27.3% of the prescriptions (reference value 100%). Antibiotics and injections appeared in 65% (reference value < 30%) and 6% (reference value < 20%) of the prescriptions. The ratio of prescription from a list of essential medicines was 15% (reference value 100%). According to the prescriber profile, the rate of prescribing an antibiotic was 63% by postgraduates in pediatrics, 70% by MBBS, and 90% by AYUSH doctors (reference value < 30%). Conclusions: More than half of the prescriptions could not attain a good score. There is room for improving prescription writing practice. Antibiotic prescription by health care providers, especially AYUSH doctors, needs to be restricted given the high number of antibiotics per prescription. This will limit the indiscriminate use of antibiotics and may be a big step towards achieving the antibiotic stewardship goal.