Deep vein thrombosis with pulmonary thromboembolism in a case of severe COVID-19 pneumonia

A 53-year-old man with diabetes came to the emergency department with fever and dry cough for 5 days, swelling of the left leg for 2 days, shortness of breath and chest pain for 1 hour. He had raised temperature, tachycardia, tachypnoea, reduced oxygen saturation and swollen tender left leg on examination. The frontal chest radiograph showed bilateral ground-glass opacities; he tested positive for COVID-19 with elevated D-dimer. The colour Doppler examination of the left leg revealed acute deep vein thrombosis (DVT) of the common femoral and the popliteal veins. The chest CT showed bilateral diffuse ground-glass opacities predominantly involving peripheral zones and the lower lobes. The CTPA revealed left pulmonary thromboembolism (PTE), treated with low-molecular-weight heparin. COVID-19 predominantly affects the respiratory system. DVT and PTE are common in COVID-19 but lethal. They should be diagnosed early by clinical and radiological examinations and treated promptly with anticoagulants.

A Case of Paraquat Poisoning Presenting With Spontaneous Pneumothorax and Pneumomediastinum

Paraquat (1,1’-dimethyl-4,4’-dipyridylium) is a liquid herbicide associated with accidental and suicidal ingestion, leading to fatal toxicity. It can lead to multiple organ dysfunction, including metabolic acidosis, acute kidney and liver injury, pulmonary fibrosis, and acute respiratory distress syndrome (ARDS). Very rarely, this can present with spontaneous pneumothorax or pneumomediastinum or both, which are poor prognostic markers with a mortality rate of almost 100%. Here, we present a young male presenting with paraquat poisoning followed by the development of both pneumothorax and pneumomediastinum and death from respiratory failure. Paraquat poisoning should always be considered in the differential diagnosis in patients presenting with spontaneous pneumothorax or pneumomediastinum in places with high paraquat poisoning prevalence.

Eosinophilic Ascites: A Rare Case Report With Diagnostic and Therapeutic Challenges

Eosinophilic ascites is a manifestation of serosal eosinophilic gastrointestinal disease. We present a 44-year-old male with low serum ascites albumin gradient with high eosinophil count and contrast-enhanced computed tomography of the abdomen showing circumferential wall thickening of the esophagus, mid to distal ileal loops, and ascending colon. The patient was managed with tablet prednisolone 20 mg twice daily for two weeks, then gradual tapering over one month. The patient responded to treatment. Awareness of the condition, timely diagnosis, and early treatment carries excellent responses.

Distribution of depressive disorders in the elderly

BACKGROUND

The community-based mental health studies have revealed that the point prevalence of depressive disorders in the elderly population of the world varies between 10% and 20% depending on cultural situations.

OBJECTIVE

To determine the median prevalence rates of depressive disorders in the elderly population of India and various other countries in the world.

MATERIALS AND METHODS

A retrospective study based on meta-analysis of various study reports.

SETTING

Community-based mental health surveys on geriatric depressive disorders conducted in the continents of Asia, Europe, Australia, North America, and South America.

STUDY PERIOD

All the studies that constituted the sample were conducted between 1955 and 2005.

SAMPLE SIZE

After applying the inclusion and exclusion criteria on published and indexed articles, 74 original research studies that surveyed a total of 4,87,275 elderly individuals in the age group of 60 years and above, residing in various parts of the world were included for the final analysis.

INCLUSION CRITERIA

The researchers had included only community-based cross-sectional surveys and some prospective studies that had not excluded depression on baseline. These studies were conducted on homogenous community of elderly population in the world, who were selected by simple random sampling technique.

EXCLUSION CRITERIA

All the unpublished reports and unavailable or unanalyzed or inaccessible articles from the internet were excluded from the study.

STATISTICAL ANALYSIS

The median prevalence rate and its corresponding interquartile range (IQR), Chi-square test, and Chi-square for Linear Trend were applied. A P value < 0.05 was considered as statistically significant.

RESULTS AND CONCLUSION

The median prevalence rate of depressive disorders in the world for the elderly population was determined to be 10.3% [IQR = (4.7%-16.0%)]. The median prevalence rate of depression among the elderly Indian population was determined to be 21.9% [IQR = (11.6%-31.1%)]. Although there was a significant decrease trend in world prevalence of geriatric depression, it was significantly higher among Indians in recent years than the rest of the world.

Socio-demographic Factors of Geriatric Depression

BACKGROUND

Depression is a common mental health problem in geriatric population and the overall prevalence rate of depression in this age group varies between 10 and 20%.

OBJECTIVE

To study the socio-demographic factors associated with depression in geriatric population.

MATERIALS AND METHODS

A systematic review was done on 74 community-based mental health surveys on depression in geriatric population, which were conducted in the continents of Asia, Europe, Australia, North America, and South America. All the studies were conducted between 1955 and 2005. The researchers had included only community-based cross-sectional surveys and some prospective studies that had not excluded depression on baseline. These studies were conducted on homogenous community of geriatric population in the world, who were selected by simple random sampling technique. A qualitative analysis was conducted to study the socio-demographic factors of depression.

RESULTS AND CONCLUSION

The two non-modifiable risk factors found to be significantly associated with depression in geriatric population were "older age group" and "female gender". However, the potentially modifiable risk factors for depression in the geriatric population were identified as low socioeconomic status, loss of spouse, living alone, chronic co-morbidities, cognitive impairment, bereavement and restricted activities of daily living (ADL).

Predictors of outcome following alcohol deaddiction treatment : a prospective longitudinal study for one year

The factors influencing the short-term outcome of alcohol dependence patients psychiatric set up were studied prospectively in an Indian population. Consecutive 60 patients with alcohol dependence syndrome according to the ICD 10 criteria, were studied. Positive outcome was noted in 55%, negative in 35%; and 10% were lost to follow up at the end of one year. There was no difference between the groups on educational level, marital status, economic status, religion, social support, associated physical or psychiatric diagnoses, type of treatment for deaddiction, age of regular drinking, days of previous abstinence and inpatient treatment days. However the negative outcome group were younger, and their average age for problem drinking was significantly less than the other group. They achieved many mile-stones of drinking career like onset of day drinking, development of dependence, diagnosis of dependence earlier. The negative outcome group also had higher psychosocial problem index, family history of alcoholism, more follow-up days using the mental health services. They did not come for follow up as quickly as the abstinent group after initiation of pathological drinking.The study suggested many clearly identifiable variables, which may distinguish prospectively patients with probable positive and negative outcome one year after the alcohol deaddiction treatment.

Non-Hodgkin's lymphoma as an unexpected diagnosis in a hip arthroplasty

Total hip replacement is routinely performed for osteoarthritis of the hip joint. We report a case of Non-Hodgkin's lymphoma as an unexpected diagnosis after routine pathological examination of the bone block harvested during total hip replacement in an asymptomatic patient. Although controversies exist regarding the cost effectiveness of routine specimen evaluation during total hip replacement, we suggest that histological analysis of any unusual-looking surgical tissues is appropriate and should be performed in all the patients who have suspicious surgical findings. To our knowledge, this is the first case of lymphoma detected during primary total hip replacement.

Genital self amputation for urinary symptom relief or suicide?

Complete combined amputation of penis and scrotum has been rarely reported. A case of an elderly male with complete genital mutilation is presented with the complexities of the phenomena. He was suffering from severe depressive episode and had experienced multiple events related to urinary system. His vulnerability to self injurious behaviour had been established by past suicide attempt. Gross impairment of judgement and depressive cognitions were instrumental in precipitating such behaviour. Related literatures are discussed.

Post discharge dropout of alcoholics - a naturalistic study in a general hospital setting

In a naturalistic longitudinal design 133 consecutive inpatients with alcohol dependence syndrome were followed up for one year following discharge from the hospital. 59 patients (group 1) paid follow up visit at regular intervals whereas 28 subjects (group 2)never returned despite three consecutive postal intimations. Rest of the patient were irregular in follow up. The individuals in group 1 were compared with those in group 2 on various sociodemographic and clinical variables with the aim of delineating the characteristics that could define the alcoholics who dropped out following discharge. It was found that such patient were relatively younger with lower level of education, less frequently married, had earlier onset of problem drinking with poor social support and higher rates of mental problems. It was concluded that post discharge attrition of alcoholics could be a social as well as a clinical problem in any setting rendering long treatment for alcoholism.

Mania in hiv infection

Mania in HIV infected individuals is an uncommon clinical presentation. It can, however, complicate any stage of the HIV infection. We herewith report a set of three case reports of patients with HIV infection who developed manic episodes. The cases highlight some aspects of the plausible relationship between HIV infection and mania. HIV infection could be revealed by manic episode, it could itself also be associated with increased cycling in bipolar patients. Mania could be secondary to HIV or zidovudine therapy (though the etiological role of the latter is as yet unclear). Mania could also occur as a reaction to awareness to having HIV infection. These relationships are important for both the physician and the psychiatrist as they have important therapeutic and prognostic implications.

Diagnosing dementia due to alzemier's disease : clinical perspective

The diagnosis of dementia in Alzheimer's disease on clinical grounds is made by exclusion of other etiologies. The differential diagnoses of other subtypes considered along with dementia of Alzheimer's disease and the clinical process involved were studied in a tertiary level health care set up. Out of 39 patients with dementia admitted over 12 years it was found that a differential diagnoses of other subtype were considered along with dementia of Alzheimer's disease in 13 cases, while 15 cases had no such association. Most frequently associated category was vascular dementia in 30.8%. The clinical difficulties in differentiating dementia in Alzheimer's disease are discussed.

Overproduced Salmonella typhimurium flagellar motor switch complexes

Three Salmonella typhimurium flagellar motor proteins, FliG, FliM and FliN, are required for the switching of rotation sense. The proteins have been localized to the cytoplasmic module of the flagellar base. Structures, which were morphologically indistinguishable from the native transmembrane MS-ring and cytoplasmic C-ring basal body modules, formed in Escherichia coli upon plasmid-encoded synthesis of these proteins together with FliF. The structures localized to the cell membrane and contained all three motor proteins, as determined by immuno-electron microscopy. This result supports the deduction, based on earlier biochemical analysis, that the C-ring is composed entirely of these proteins and, therefore, functions as a dedicated motor component. In addition, it demonstrates that the morphologically correct assembly of the C-ring onto the MS-ring proceeds independently of other structural components of these modules.

Autistic features in children with mental retardation

Most of the autistic disorder patients are also mentally retarded and many mentally retarded persons exhibit autistic symptoms. By using a standard instrument (Ritvo-Freeman Real Life Rating Scale) the autistic features of the mentally retarded children were studied. The study also examined the influence of age, sex and level of mental retardation on the occurrence of autistic symptoms. Children who came for consultation to child psychiatric unit were compared with those at a school for children with mental retardation receiving stimulation. Male children from child psychiatric unit had significantly higher scores than those from the school. Social and language impairment could be reliably identified and grouped. It was possible to diagnose the syndrome of autism in children with mental retardation in a significant number (9.6%)as compared to that was possible only clinically (1.9%). More number of children with severe/ profound mental retardation could be diagnosed as autistic. The autistic syndrome in children with mental retardation can be picked up more effectively by the use of structured instrument.

A study of major physical disorders among the elderly depressives

Psychiatric evaluation and assessment of common physical illnesses and disabilities was carried out in elderly depressives (aged 60 years and above). Correlation, if any, was seen between depression and physical problems. The 'patient group' comprised of 40 drawn from MHI, Cuttack, having a depressive disorder (ICD-10). The 'control group' of 20 was drawn from the general population with no psychiatric disorder. The presence of physical illness was looked for in both groups. The patient group had physical illnesses, 76% of which were previously undiagnosed. The control group had physical illnesses 71% of which were previously diagnosed. Undiagnosed physical illnesses are more common among elderly patients with depression than among matched control. The physical illnesses contributed in two thirds of the patients. So careful detection and management of physical illness is of equal importance in the management of depression.

A short communication on occurrence of rheumatic diseases attending hospital

A total of 4800 patients suffering from rheumatic diseases, attending Department of Physical Medicine, Burdwan Medical College Hospital, West Bengal, during the period from January 1991 to June 1991, were studied. Out of these 4800 cases, soft tissue rheumatism cases were maximum (57%), followed by osteo-arthrosis cases (36%), rheumatoid arthritis (5.2%), rheumatic arthritis (0.4%), ankylosing spondylitis (0.6%), osteo-chondrosis (0.7%) and gouty arthritis (0.1). Soft tissue rheumatism cases were common (62.8) in age group 20-40 years, mainly (58.4%) in female and maximum (37%) of lumbosacral strain. Osteo-arthrosis cases were highest (53.9%) in 40-60 years of age with female preponderance (57.2%) and mainly (49%) of cervical spondylosis.

Prediction of recovery of Bell's palsy from clinical manifestations

Sixty patients of Bell's palsy aged between 8 and 72 years, comprising 31 males and 29 females, were studied clinically to find out a method of prediction of recovery in early stage. It was found that young patients with incomplete palsy, unaccompanied by postauricular pain, loss of taste sensation over anterior 2/3rds of tongue hyperacusis and dry eye and recovery beginning within 4 weeks of onset of palsy are likely to make complete recovery, while older patients with complete palsy accompanied by severe postauricular pain, loss of taste sensation, hyperacusis and dry eye and beginning of recovery after 4 weeks of onset of palsy are most likely to have incomplete recovery.

Study of triangular fibrocartilage of the wrist joint in Colles' fracture

Poor results in Colles' fracture may be due to tears of the triangular fibrocartilage at the wrist joint. A series of patients have been studied by arthrography of the wrist; some were operated on and the findings confirmed. A series of 60 patients was studied.