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   Table of Contents - Current issue
Coverpage
April 2022
Volume 11 | Issue 2
Page Nos. 45-88

Online since Wednesday, April 6, 2022

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REVIEW ARTICLE  

Electrocardiographic abnormalities in prevalent infections in tropical regions: A scoping review p. 45
Gautam Jesrani, Samiksha Gupta, Saurabh Gaba, Monica Gupta
DOI:10.4103/2221-6189.342660  
Cardiovascular manifestations and electrocardiographic abnormalities have been reported among some prevalent infections in tropical regions, which lead to a great amount of morbidity and mortality. The major infectious diseases include chikungunya, dengue fever, H1N1 influenza, and coronavirus disease-19 (COVID- 19) in the viral category, leptospirosis, salmonellosis, scrub typhus and tuberculosis in the bacterial category, and malaria in the protozoan parasite category. All these infirmities constitute a foremost infection burden worldwide and have been linked to the various cardiac rhythm aberrancies. So we aimed to identify and compile different studies on these infections and associated acute electrocardiographic (ECG) changes. The search was made in online international libraries like PubMed, Google Scholar, and EMBASE, and 38 most relevant articles, including original research, systematic reviews, and unique case reports were selected. All of them were evaluated thoroughly and information regarding ECG was collected. Myocarditis is the predominant underlying pathology for rhythm disturbance and can be affected either due to the direct pathogenic effect or the abnormal immune system activation. ECG variabilities in some infections like chikungunya, scrub typhus, and leptospirosis are associated with longer hospital stay and poor outcome. Tropical infective diseases are associated with prominent acute cardiac rhythm abnormalities due to myocarditis, which can be identified preliminarily by ECG changes.
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ORIGINAL ARTICLES Top

Goal-directed fluid therapy in gastrointestinal cancer surgery: A prospective randomized study p. 52
Duygu Akyol, Zafer Cukurova, Evrim Kucur Tulubas, Güneş Özlem Yıldız, Mehmet Süleyman Sabaz
DOI:10.4103/2221-6189.342661  
Objective: To investigate the effects of perioperative goal-directed fluid therapy (GDFT) on intraoperative fluid balance, postoperative morbidity, and mortality. Methods: This is a prospective randomized study, and 90 patients who underwent elective open gastrointestinal cancer surgery between April 2017 and May 2018 were included. Patients were randomized into 2 groups that received liberal fluid therapy (the LFT group, n=45) and goal-directed fluid therapy (the GDFT group, n=45). Patients’ Colorectal Physiologic and Operative Severity Score for the enUmeration of Mortality and Morbidity (CR-POSSUM) physiological score, Charlson Comorbidity Index (CCI), perioperative vasopressor and inotrope use, postoperative AKIN classification, postoperative intensive care unit (ICU) hospitalization, hospital stay, and 30-day mortality were recorded. Results: The volume of crystalloid used perioperatively and the total volume of fluid were significantly lower in the GDFT group compared to the LFT group (P<0.05). CR-POSSUM physiological score and CCI were significantly higher in the GDFT group (P<0.05). Although perioperative vasopressor and inotrope use was significantly higher in the GDFT group (P<0.05), postoperative acute kidney injury development was not affected. Postoperative mortality was determined to be similar in both groups (P>0.05). Conclusion: Although GDFT was demonstrated to be a good alternative method to LFT in open gastrointestinal cancer surgery, and it can prevent perioperative fluid overload, and the postoperative results are comparable in the two groups.
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Comparative study on effects of dexmedetomidine and dexamethasone on the incidence of postoperative nausea and vomiting in patients undergoing laparoscopic surgery p. 59
Manpreet Singh, Awadh Bihari Tiwari, Priya Taank, Shalendra Singh, Amrinder Kaur, Munish Sood, Rahul Yadav
DOI:10.4103/2221-6189.342662  
Objective: To compare the safety and efficacy of dexmedetomidine and dexamethasone for the prevention of postoperative nausea and vomiting (PONV) in patients scheduled for laparoscopic surgery. Methods: A total of 86 female patients were prospectively administered dexmedetomidine 1 μg/kg i.v. (the group A, n=43), and dexamethasone 8 mg i.v. (the group B, n=43). The two groups were compared in treatment response, hemodynamic changes, and Numerical Analog Scale (NAS). Besides, the relation of PONV with patient baseline characteristics in the perioperative period was determined as well. Results: Patients in group A had lower PONV scores (t=3.1, P<0.002), less needs for rescue anti-emetics (χ2=0.47, P<0.001), and decreased intraoperative heart rate (t=9.72, P<0.001) and mean arterial pressure (t=7.58, P<0.001) compared to that of group B. Group A reported lower NAS than group B (t=2.66, P<0.001). In addition, we found no relationship between PONV score and rescue anti-emetic requirement, age, or body mass index (P=0.96, P=0.60, P=0.28, respectively). Conclusion: Dexmedetomidine could be used as an effective antiemetic in laparoscopic surgeries, with better efficacy than dexamethasone. Dexmedetomidine not only can reduce PONV but also is effective in postoperative analgesia.
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Effect of cold weather on carotid artery stenosis and occlusion: A retrospective observational study p. 65
Hamissou Moussa Maman Roufai, Jun Yang, Guang-Fu Song, Fu-Yi Yang
DOI:10.4103/2221-6189.342663  
Objective: To investigate the effect of cold weather on carotid artery stenosis and occlusion. Methods: We conducted a retrospective observational study, in which 145 patients with carotid artery stenosis and occlusion were enrolled [115 men and 30 women; the mean age was 61.08 years (95% CI 59.27-62.88)]. Patients were divided into the low-temperature group (n=98) (≤12 °C) and the non-low temperature group (n=47) (>12 °C). Clinical characteristics, blood pressure, National Institutes of Health Stroke Scale (NIHSS), blood fat, and blood viscositys were compared between the two groups. Correlation between NIHSS and mean daily temperature was analyzed. Results: There was no significant difference in the systolic and diastolic blood pressure between the two groups (P>0.05). The NIHSS score was slightly higher in the non-low temperature group compared to that of the low-temperature group (U=2 984, P<0.01). Glycemia, cholesterol level, prothrombin time, fibrinogen, and International Normalized Ratio did not show any significant difference (P>0.05). Correlation analysis showed a very low positive and statistically significant correlation between ambient temperature and NIHSS score (r=0.18, P=0.029). Conclusion: Cold weather does not impact blood pressure, blood cholesterol, and coagulation factors of patients with carotid artery stenosis and occlusion. The neurological deficit is more severe in the non-low ambient temperature group. A potential relationship exists between ambient temperature and the level of neurological impairment.
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Body mass index and COVID-19 outcomes: A retrospective cross-sectional study at a tertiary care center in India p. 71
Hardeva Ram Nehara, Sahdev Kumawat, Rohitash Kularia, J Amareshwara, Prashant Kumar Batar, Vivek Goudgaon
DOI:10.4103/2221-6189.342664  
Objective: To determine the association between body weight and COVID-19 outcomes. Methods: This is a retrospective cohort study of COVID-19 patients admitted in a dedicated COVID-19 hospital, a tertiary health care center, between May and June 2021. Demographic data and baseline variables, including age, sex, body mass index (BMI), and comorbidities were collected. Outcomes (death or mechanical ventilation) of the patients with different BMI, age, comorbidities, and qSOFA scores were compared. Besides, the risk factors for death or mechanical ventilation were determined. Results: The mean age of the subjects was (51.8±14.7) years old, and 233 (74.2%) were male. There were 103 (32.8%) patients with normal weight, 143 (45.5%) patients were overweight, and 68 (21.7%) patients were obese. In-hospital deaths and need of mechanical ventilations were significantly higher in the obese and the overweight group compared to the normal weight group, in age group ≥65 years compared to <65 years, in patients with ≥1 comorbidities compared to patients without comorbidities, in patients with qSOFA scores ≥2 compared to patients with qSOFA scores<2. There was a significantly increased risk of death (RR: 4.1, 95% CI 1.0-17.4, P=0.04) and significantly increased need of mechanical ventilation (RR: 5.2, 95% CI 1.8-15.2, P=0.002) in the obese patients compared with those with normal weight after controlling other covariates. Conclusion: Obesity is one of the significant risk factors for adverse outcomes in COVID-19 patients and should be considered during management.
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Mortality characteristics during the two waves of COVID-19 in India: A retrospective observational study p. 77
Nalini Ramesh Humaney, Shilpa Sachin Kuthe, Shamim Akhtar, Vivek K Pande
DOI:10.4103/2221-6189.342665  
Objective: To evaluate patient demographic characteristics and risk factors for mortality during the first and the second wave among COVID-19 patients in a tertiary care hospital of India. Methods: Data were taken from the hospital’s electronic system for COVID-19 patients from August 2020 to December 2020, and the second from January 2021 to May 2021. The mortality rate, demographic and clinical characteristics, laboratory profile, and reasons for the death of the two waves were retrieved and compared, and the risk factors of the two waves were determined. Results: In the first wave, 1 177 COVID-19 cases visited the hospital and 96 (8.2%) died. In comparison, the death rate in the second wave was significantly higher (244/2 038, 12.0%) (P<0.001). No significant difference in age [60 (50-69) vs. 60.5 (53-70), P=0.11] or gender (P=0.34) was observed between the two waves. Compared to the first wave. there were significantly more cases with fever, cough, weakness, loss of taste and smell, and sore throat during the second wave (P<0.05), but significantly fewer cases with kidney disease (6.6% vs. 13.5%, P=0.038) and diabetes mellitus (35.7% vs. 50.0%, P=0.015). Besides, during the second wave, more patients had abnormal X-ray findings, higher levels of lymphocytes and serum ferritin (P<0.05). In addition, there were significant differences in the rate of death cases with acidosis, septic shock, acute kidney injury, diabetes mellitus, cardiovascular events, hypothyroidism (P<0.05). Multivariate regression showed that during the first wave, age (OR: 1.10; 95% CI: 1.02-1.21), diabetes mellitus (OR: 3.16; 95% CI: 2.08-3.53), and abnormal X-ray (2.67; 95% CI: 2.32-2.87) were significant independent risk factors of mortality; while in the second wave, age (OR: 1.13; 95% CI: 1.12-1.28), diabetes mellitus (OR: 8.98; 95% CI: 1.79-45.67), abnormal X-ray (OR: 12.83; 95% CI: 2.32-54.76), high D-dimer (OR: 10.89; 95% CI: 1.56-134.53), and high IL-6 (OR: 7.89; 95% CI: 1.18-47.82) were significant independent risk factors of mortality . Conclusion: Overall mortality and incidence of severe diseases are higher in the second wave than the first wave. Demographic characteristics, co-morbidities, and laboratory inflammatory parameters, especially D-dimer and IL-6, are significant risk facors of mortality during the COVID-19 pandemic.
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CASE REPORT Top

An alveolate kidney: A case report of emphysema pyelonephritis p. 85
De-Gang Wang, Jian-Jiao Chen
DOI:10.4103/2221-6189.342666  
Rationale: Emphysematous pyelonephritis is a life-threatening infectious disease that requires early diagnosis and treatment. The disease is often misdiagnosed due to its diversity of clinical manifestations. Patient’s concern: A 62-year-old woman was admitted to the emergency department following a 12-hour history of abdominal pain and dyspnea. Physical examination showed percussion pain on the right costovertebral angle. Besides, she had a history of diabetes mellitus and urinary calculus. Diagnosis: Emphysematous pyelonephritis. Intervention: The patient accepted antishock therapy, tight glucose control, and broad-spectrum anti-infective therapy. After stabilization of the general condition, an ultrasound-guided percutaneous nephrostomy was performed. Outcome: Her conditions became stable over the following days. She presented a favorable clinical course, with normalization of renal function and positive improvements in imaging findings in a month. Lessons: Early diagnosis and rapid medical management are the keys to successful treatment. CT is an important method for the diagnosis of emphysematous pyelonephritis. For patients with severe lesions, percutaneous renal drainage combined with active anti-infection should be given in time.
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LETTER TO EDITOR Top

Early severity predictors of snakebite envenomation in the southern region of Tunisia p. 88
Godpower Chinedu Michael
DOI:10.4103/2221-6189.342667  
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