Background: Patients with chronic obstructive pulmonary disease (COPD) often have cardiovascular comorbidities. Patients of COPD with cardiovascular complications tend to have more symptoms and a higher mortality than do patients with COPD alone. There are several cardiac biomarkers such as Troponin-T, creatine phosphokinase-MB (CPK-MB), and N-terminal pro-brain natriuretic peptide (NT-proBNP) which can be used to detect cardiac dysfunction in patients of COPD. Retrospective studies suggest that plasma levels of NT-proBNP and cardiac Troponin-T are often elevated in patients with acute exacerbations of COPD and are associated with increased mortality. Aims and objectives: In this study, we assessed the presence of cardiac dysfunction in patients presenting with acute exacerbation of COPD (AECOPD) by using cardiac biomarkers proBNP, Troponin-T, and CPK-MB. Patients were followed up for 30 days to know the relationship between cardiac dysfunction and outcome in terms of repeated admissions, intensive care units (ICU) admissions, and/or mortality. Methodology: Ninety patients of AECOPD were enrolled in our study. A detailed history was taken and physical examination performed in these patients. All patients in the study were subjected to hematological and biochemical investigations. ProBNP, Troponin-T, and CPK-MB were measured within 48 h of admission as measure of cardiac dysfunction; and outcome was assessed in terms of mortality, ICU admission, and repeated admissions within 30 days of admission. Results: Among the study population, 77.77% had at least one deranged cardiac biomarker, and 18.88% of populations had all the three biomarkers of cardiac dysfunction deranged. 24 out of the 90 participants required ventilatory support in the form of noninvasive or invasive ventilation. 7.14% of the study population had repeated admissions, 24.28% had ICU admissions and 11.43% had mortality. All of them had deranged cardiac biomarkers. There was a significant association between deranged proBNP and ICU admission and mortality (P = 0.0151 and 0.0217, respectively). COPD was more prevalent in the age group of 50–70 years and in males. ProBNP levels were significantly elevated in patients who required ventilatory support (P = 0.003). Conclusions: Cardiac dysfunction is common during exacerbations of COPD and portends a poor prognosis. Cardiac dysfunction was more prevalent in the elderly. Patients with deranged cardiac biomarkers had a greater number of ICU admissions, repeated hospital admissions, and a higher mortality. In the follow-up, elevated proBNP was found to be a strong marker for predicting ICU admission, mortality, and repeated admissions.

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Background: The primary central nervous system (CNS) demyelinating disorders are witnessing significant advancement in terms of treatment options and the diagnostics. However, a resource poor country like ours has to rely more on our clinical findings. Aims and Objectives: To study the spectrum of different clinical manifestations in patients of various primary CNS demyelinating disorders in the hospital setting; categorizing them to the most possible extent into its various types viz. multiple sclerosis(MS), neuromyelitis optica spectrum disorder (NMOSD), acute disseminated encephalomyelitis(ADEM), idiopathic optic neuritis(ON). Metarials and Methods: An observational study was conducted for 2 years including old and newly diagnosed cases in whom detailed clinical assessment was done for every attack including the previous and subsequent ones. Statistical analysis was done using SPSS version 21. Results: Of the 47 patients included, 26 (55.3%) were cases of NMOSD, 12 (25.5%) of MS, 4 (8.5%) of ADEM and 5 (10.6%) were isolated cases of ON. 30 were female and 17 were male (ratio 1:0.6). The total mean age for primary CNS demyelinating disorders at presentation was 27.09 ± 13.44 years. Maximum patients fell in the age range of 11–20 years. Among the clinical manifestations, motor abnormalities (97.6%), sensory abnormalities (69%), bladder dysfunction (59.5%), visual manifestations (54.8%) (Unilateral in all MS patients, both bilateral and unilateral in NMOSD) were the most common presentations. In MS, the most common manifestations were motor dysfunction followed by sensory symptoms, optic neuropathy (mostly unilateral), and bladder dysfunction. In NMOSD, the most common clinical manifestations were motor dysfunction, followed by bladder dysfunction, optic neuropathy and then sensory abnormalities. In ADEM, most common manifestations were motor abnormalities, acute encephalopathy, headache, optic neuropathy. Among idiopathic ON, most patients presented with painful diminution of vision (80%). Mean number of attacks was 2.53. Conclusion: A wide spectrum of clinical presentations in various disorders of primary CNS demyelination was found with maximum patients presenting with motor dysfunction in various forms.

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High anion gap metabolic acidosis is a common acid–base disorder encountered in hospitalized patients and more so in the intensive care unit. The most common causes are accumulation of lactate, ketones, and urea and ingestion of certain toxins. In the absence of these, lesser-known etiologies such as accumulation of D-lactate or pyroglutamic acid (PGA) should be suspected. PGA (5-oxoproline) is an endogenous organic acid that can accumulate in serum to cause anionic gap metabolic acidosis. This can occur with inherited defects in enzymes that participate in the y-glutamyl cycle or can be acquired in association with therapeutic paracetamol use, malnutrition, sepsis, antibiotics, and renal impairment. Our case illustrates that prompt recognition of this entity and discontinuation of offending agents such as paracetamol result in rapid recovery, thus reducing the hospital stay.

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Background: Extrapulmonary multisystemic manifestations in children were recognized, early in the pandemic, Multisystem Inflammatory Syndrome in Children (MIS-C). Of late, similar manifestations have been reported in adults (Multisystem Inflammatory Syndrome in adults - MIS-A) in too. As new variants of SARS-CoV 2 emerge and fade away, MIS-A needs to be recognized at the most opportune time. Besides, we hypothesize that MIS-A may also co-exist with other tropical infections to further confuse diagnostic scenario. Methodology: A series of five cases of MIS-A is presented. Their demographic, comorbidities, and clinical data were noted. Besides, the clinical and laboratory parameters of patients with and without tropical infections were compared. Results: Patients presented with diverse heterogenous clinical manifestations. The cardiovascular, hematological, and abdominal systems were most commonly involved along with high inflammatory markers. Three of our patients in the present series had tropical infections along with MIS-A. There was no statistically significant difference between clinical manifestations and laboratory parameters among MIS-A patients with and without tropical infections. All the five patients improved on treatment and were discharged home. Conclusions: A high index of suspicion is required to diagnose MIS-A, especially in tropical areas where background rate of other infections is also high. Moreover, these tropical infections may co-occur along with MIS-A, further confusing the diverse heterogenous clinical presentations. Patients with MIS-A may be critically ill, but outcomes are good if lifesaving immunosuppressive therapy is initiated on time.

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Aim: The aim is to analyze various possible etiological factors for the sudden outbreak of mucormycosis. Methods: A prospective observational study involving consecutive individuals with proven mucormycosis was undertaken at a tertiary care teaching hospital in North India from May 2021 to July 2021. A total of 88 patients with mucormycosis were studied for the demographic profile, COVID-19 status, various risk factors, COVID-19 immunization status, clinical staging of disease, and outcome of patients. Results: Out of 88 patients, 54 (61%) were males and 34 (39%) were females. The mean age of male patients was 50.5 ± 13.8 and female patients was 52.1 ± 14.1. Most of the patients were in stage two, i.e., 45 (51.1%) and 26 (29.5%) in stage three of the disease. Past history of diabetes was present in 49 (55%) patients. Forty-one (46.6%) patients had documented Reverse Transcription Polymerase Chain Reaction (RTPCR) reports in favor of COVID-19 and others had clinical features consistent with COVID-19. Only 1% of patient took COVID-vaccination. Of the total 88 patients, 42 (47%) were on oxygen therapy, 72 (81%) had history of blood transfusion, and 48 (54%) were given steroids. Conclusions: No conclusive etiological factor was identified although few recommendations are suggested for prevention, early diagnosis, and prompt management of mucormycosis in hospitalized COVID-19 patients.

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Context: Poststroke seizures are not infrequent neurological sequelae of stroke. Aims: The primary aim of our study is to determine the frequency of early seizures in acute ischemic stroke in our population. Subjects and Methods: It is a descriptive cross-sectional study done at the Department of Neurology, Dr. Ruth K. M. Pfau Civil Hospital Karachi, Pakistan. The duration of the study was of 6 months, from July 2019 to December 2019. All patients who fulfilled the inclusion criteria were enrolled in the study after Institutional Review Board approval. Informed and written consent was obtained from all subjects. A detailed history and clinical examination were carried out and all patients were assessed by a trained neurologist. Results: Total 281 patients with ischemic stroke were included. One hundred and eighty-one patients (64.4%) were male and 100 (35.6%) were female with a mean age of 48.41 ± 8.730 years. The early-onset seizures were noted in 22 patients (7.8%). In our study, early-onset poststroke seizures were noted more commonly in the age group of 36–60 years and were predominant in the males. Patients with infarction in the parietal lobe exhibited greater seizure occurrence. The most common seizure type observed was generalized tonic–clonic. Majority of early-onset poststroke seizures occurred in the 1^st week. Conclusion: In our study, the frequency of early onset seizures in patients with ischemic stroke was found to be 7.8%, which when occurs increases morbidity.

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Background: Urinary tract infections (UTIs) are one of the most common bacterial infections in humans, both in the community and the hospital settings. The distribution of antimicrobial susceptibility data of UTI-causing microorganisms changes from time to time and from place to place. The susceptibility data provided by regional microbiology laboratories helps to choose the empirical antimicrobials to treat UTI. Aim and Objectives: To determine the prevalence and antimicrobial drug susceptibility pattern of the bacterial uropathogens isolated from a tertiary care hospital. Material and Methods: A retrospective analysis over a period of two months (Jan-Feb 2021) was performed in the Department of Microbiology of a tertiary care hospital, East part of Delhi. These two months were immediately following conversion of this facility to a non COVID centre from a dedicated COVID centre. Culture results of the urine samples received during the study period were analyzed. The samples were processed according to standard guidelines. The data were entered into micro soft excel for analysis. Results: A total of 1650 urine samples from suspected UTIs were analyzed retrospectively for isolation and identification of bacteria and antimicrobial susceptibility testing. 271 (16.4%) grew significant microorganisms including fungus. In both male and female patients E. coli (n = 46, 17%) was the most commonly isolated microorganism, followed by Staphylococcus spp. (n = 45, 16%). Isolated resistance to uropathogens was common with Cotrimoxazole (60%), Nitrofurantoin (50%), ciprofloxacin (50%), tetracycline (45%), Imipenem and cefotaxime (35%) Conclusions: UTI is one of the most common infectious diseases that clinicians are dealing with. Increasing antimicrobial resistance among uropathogens implicated in UTI is a matter of concern. Periodic monitoring of etiology and drug susceptibility is recommended.

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Klippel‒Feil syndrome, is a congenital disorder characterized by congenital fusion of two or more cervical vertebrae. Classically, there is triad of short neck, a low posterior hairline, and a limited range of neck movements. Less than half patients present with all three classical features. The presence of other anomalies may be associated with increased morbidity so complete evaluation and further management are critical in every case. Here, we are reporting a case with all clinical triad with associated mirror movements.

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Background: Dengue is one of the major public health problems in the world. Currently, dengue is endemic in more than 100 countries of Asian pacific region. Prevention and control of dengue is largely influenced by the level of awareness and the preventive practices people undertake. In this background, the present study was conducted to find out the relationship between Aedes aegypti indices and perception and practices regarding dengue and its prevention. Materials and Methods: This cross-sectional study was conducted in an urban slum for the period of 1 year among 270 households selected by probability proportionate to size technique. Data were collected by structured questionnaire with details on sociodemographic characteristics, perception, and practices adopted by people toward dengue and its prevention. Larva survey was conducted by observing for the A. aegypti larvae in the containers within and outside the households. Results: Among 270 households included in the present study, overall, 70 (25.9%) and 96 (35.6%) of the study respondents were having poor and average levels of perception. 22 (8.1%) and 163 (60.4%) of respondents had poor and average levels of dengue prevention practices, respectively. Household index, container index, and Bretau's index (BI) were 5.52%, 6.05%, and 8.51%, respectively. Median perception and practice scores among the respondents of households with larva breeding were significantly lower as compared to the ones without larva breeding. Conclusion: Majority of the study participants had poor to average levels of perception and practices regarding dengue and its prevention. These scores were significantly lower among households with active larva breeding.

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Benign metastasizing leiomyoma (BML) is an uncommon disorder characterized by occurrence of benign smooth muscle tumor with identical features as uterine myoma in extrauterine sites. The most documented site is the lungs, but other areas of the body have been reported. The case of a 44-year-old woman who had BML following an earlier open myomectomy is reported. The presentation mimicked an advanced intra-abdominal tumor with lung involvement, and this posed a diagnostic dilemma, especially with the worsening breathlessness and rapid deterioration of the patient's clinical condition. Autopsy provided an insight into this rare case which was confirmed by histology and immunohistochemistry of the masses in the thoracic and abdominal cavities. BML can easily be misdiagnosed but, if promptly detected, medical and surgical management options could be lifesaving for the affected patients. There is a need for a high index of suspicion in patients who have had previous surgeries for fibroids presenting with pressure symptoms from regions other than the pelvis.

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Pancytopenia is an uncommon hematological finding in patients with Sheehan's syndrome. Our case is an adult female who presented after 12 years of severe postpartum hemorrhage with symptomatic hypoglycemic attacks and pancytopenia on hemogram. Hormone replacement corrected pancytopenia within a week.

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We report a rare case of critical coronary artery disease in a 62-year-old male with achondroplasia. There is a paucity of case reports of association of achondroplasia with coronary artery disease. Left main coronary artery (LMCA) bifurcation lesion carries the highest risk of mortality out of all types of coronary artery lesions and patients with achondroplasia have two-fold more mortality as compared to the general population. That is why achondroplasia patients may be having more sudden cardiac death with the most catastrophic LMCA bifurcation lesion before they undergo revascularization. It may be the plausible explanation behind no literature description of LMCA bifurcation lesion in patients with achondroplasia. Our case is the first literature description of LMCA bifurcation lesion with successful intervention in achondroplasia. The present case will also provide a detailed insight into the association of achondroplasia with coronary artery disease without the presence of conventional cardiac risk factors.

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Brain abscesses are rare and potentially lethal neurological lesions, requiring prompt attention. Although brain abscesses are known to complicate surgically intervened intracerebral hemorrhages (ICH), but the formation of a brain abscess at the site of an ICH treated without surgery is exceptional. We hereby report a case of a 14-year-old female presenting with a brain abscess 6 weeks after an episode of spontaneous ICH with no identifiable focus of infection. She was effectively treated with antibiotics in combination with craniotomy and excision of abscess and was discharged with good recovery.

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