Kerala Medical Journal

Post-Covid Fatigue a Way Forward

PV Benny — Fri, 26 Mar 2021 00:00:00 -0700

Post-COVID fatigue and anhedonia are common after recovery from novel coronavirus infection that affects all domains of life of the patients. In this context, fatigue is defined as the decrease in physical and/or mental performance that results from changes in central, psychological, and/or peripheral factors due to the COVID-19 disease .Many patients with “Long Covid” are experiencing extreme fatigue, a condition that repolarizes treatment and rehabilitation methods. Some patients with lung injury experience persistent respiratory symptoms, but for those who were previously healthy and without other complications, the prospects are good, and functional recovery is better than expected by radiological evidence. For many people, persistent physical and mental fatigue is a disturbing reality. Of those patients with any prolonged fatigue syndrome initially, 58% still reported fatigue 12 months later. Most importantly, the risk of developing prolonged fatigue was not increased in patients who initially had psychological distress, neither was the risk of developing psychological distress increased in patients who initially had prolonged fatigue.

A Study to Assess the Validity of Community based Assessment Checklist – The Standard Non- Communicable Diseases Screening Tool of Frontline Health Workers

Fri, 26 Mar 2021 00:00:00 -0700

Backgrounds: Around 63% of deaths in India are due to non-communicable diseases (NCD), and 1 in 4 Indians is at risk of premature death between 30 to 70 years of age. Considering this burden, the Government of India has introduced a Community Based Assessment Checklist (CBAC) to be used by frontline health workers for universal screening of populations aged more than 30 years for common NCDs as a part of Health and Wellness Centres under Ayushman Bharat.
Objectives: This study aimed to assess the validity of CBAC in the screening of common NCDs like diabetes mellitus and hypertension.
Methods: A cross-sectional study was done in the rural southern part of India among adults aged more than 30 years. A total of 110 participants were screened using CBAC. Random blood glucose(RBS) and blood pressure were measured. RBS more than 200 mg/dl and blood pressure equal to or more than 140/90 mmHg were considered as operational diagnostic criteria. The CBAC score >4 was considered to be a risk for these NCDs. Data were collected in MS excel, and analysis was done using R software.
Results: A majority of participants belonged to the age group above 50 years (71%) and male sex (69%). The study participants’ median (IQR) CBAC score was 5 (4-6), and 70% had scored more than 4. About 45% of participants had blood pressure equal to or more than 140/90 mmHg, 15% had RBS > 200 mg/dl, and 51% had at least one abnormal parameter. The sensitivity of the current CBAC score cut-off was 85.7% and 53.7%, respectively. Analysis showed that if the cut-off score is reduced to equal to or more than 4, sensitivity increases to 98%.
Conclusion: Community based assessment checklist is a valid tool for NCD screening and high-risk behaviour among the community. However, decreasing the cut-off score to equal to or more than four will increase the sensitivity of CBAC.

Mucormycosis

Roshan J Lewis — Fri, 26 Mar 2021 00:00:00 -0700

Mucormycosis is sometimes called Zygomycosis. It is a rare but serious fungal infection caused by a group of molds called mucormycetes. These fungi are ubiquitous in the environment, inhabiting soil especially decaying organic matter, such as leaves, compost piles, or rotten wood. They are more common in soil than in air, and in summer and fall than in winter or spring.

p.Arg142Ter Variant Causing IFT52 Gene Mutation Resulting in Asphyxiating Thoracic Dystrophy-Juene Syndrome-A Rare Case Report

A C Mammen, P V Binukuttan, Reni G Varghese, Salini Sasidharan — Fri, 26 Mar 2021 00:00:00 -0700

Asphyxiating thoracic dystrophy or Juene syndrome is a rare condition of congenital dwarfism. Incidence is 1 per 100000-130000 live births1.A term neonate born in our hospital had respiratory distress soon after birth. On examination, the baby had polydactyly on all four limbs and small bell-shaped thorax. Xray revealed small metacarpals, short ribs, short iliac bones acetabular spurs.Mutation analysis revealed mutation in the gene coding IFT52 in Exon 6 with pArg142Ter as variant.Since this variant is reported less in literature,we report this case.

RT-PCR Negative COVID 19 – Akin to Smear Negative Pulmonary Tuberculosis? – A Case Report

Fri, 26 Mar 2021 00:00:00 -0700

We report a case of 34-year-old physician who presented with classical clinicoradiological features suggestive of COVID-19 but five sequential rRT-PCR (real time Reverse Transcription Polymerase chain reaction) tests were negative. After admission, he was hypoxic and febrile. He had clinical worsening and laboratory parameters suggestive of an impending cytokine storm and he was appropriately managed as per institution protocol. Meanwhile, his antibody test for COVID 19 came positive for both Ig G and Ig M with high IgM level. He had a dramatic recovery and was discharged within 10 days. It is difficult to distinguish COVID-19 pneumonia from other viral pneumonia based on RT-PCR and CT findings alone. In this context, this case report is being published to highlight this fact.

Emergence of Stenotrophomonas Maltophilia Sepsis - A Case Series and Review of Literature

Fri, 26 Mar 2021 00:00:00 -0700

Stenotrophomonas maltophilia is an emerging nosocomial pathogen that causes fatal infections in critically ill or immunocompromised patients. S.maltophilia bacteremia (SMB) is a rare condition and is assosciated with morbidity and mortality, and its optimal management remains ill defined. The aim of the current study is to review the management of S.maltophilia bacteremia1.
We described five cases of S.maltophilia bacteremia in immunocompromised patients over a period of 6 months from September 2019 to February 2020. In the current review, a few cases had undergone surgical intervention prior to the onset of bacteremia. Prolonged antibiotic therapy (eg carbapenam), healthcare exposure , and prior surgical procedures were the major risk factors associatd with S. maltophilia infection in healthcare settings. Optimal therapy is based on antimicrobial sensitivity , and the trimethoprim-sulfamethoxazole based combination has been shown to be successful.