COVID-19 Infection In Patients With Autoimmune Rheumatic Diseases: Patient's Perspective And Descriptive Analysis From A Lower-Middle-Income Country

The study was conducted to determine the severity of COVID-19 in autoimmune inflammatory rheumatic disease (AIRDs) patients and knowing their perceptions. All AIRDs cases with COVID-19 infection between December 2020 and February 2021 were included. A cross-sectional telephonic survey was conducted for perceptions. Twenty- one patients were analysed for severity of illness and 16(76.2%) for perceptions. Mean age was 44.8±14.8 years, with 11(52.4%) females. Two (9.5%) patients had severe disease, 6(28.6%) required hospitalisation, and none expired. Hypertension 7(33.3%) was the commonest comorbidity. Low dose steroids were the most used drug 9 (42.9%). Regarding perceptions, 10 out of 16 (62.5%) felt that AIRD made them vulnerable to COVID-19 infection. The most common reason of delay in seeking medical advice from the rheumatologist was closure of services for chronic diseases during the pandemic. Patients with AIRDs, receiving immunosuppressive treatment seem to be at a lower risk of developing a severe form of COVID-19 pneumonia.

Duodenal Perforation in a Patient with Dengue Fever –A Rare Entity

A 37-year-old gentleman presented to the emergency with a history of high-grade fever for 2 days and abdominal pain for one day. On arrival at the emergency department, he was hypotensive and tachycardic, while on abdominal examination he had generalized abdominal tenderness. He was started on fluid resuscitation with intravenous crystalloids. The initial impression was of an acute abdomen. The Abdominal X-ray showed air under the diaphragm. He was rushed to the operating room and underwent an emergency laparotomy that revealed a duodenal perforation for which he underwent Graham's patch repair and washout. No obvious cause was identified. He had low platelets for which Dengue NS-1 antigen was sent that came positive. Post-procedure he recovered and was discharged home. To our knowledge, this is the first case in which dengue fever associated with a duodenal perforation is being reported. It is the first case of gastrointestinal perforation in a patient with Dengue Fever to be reported outside of India. In endemic regions, clinicians must recognize such atypical manifestations.

Late ventricular potentials and heavy drinking

OBJECTIVES

To assess the effects of chronic drinking on detection of low amplitude signals, and to determine the relation between late ventricular potentials (LVP) and liver biopsy findings.

DESIGN

Prospective study.

SETTING

General hospital.

PATIENTS

41 consecutive chronic alcoholics without known pre-existing heart disease.

METHODS

About four days after each patient's last alcoholic drink, ECG, echocardiography, signal averaged electrocardiogram, liver biopsy, and blood tests were performed.

RESULTS

Twenty eight per cent of patients had evidence of LVP. There was a correlation between the percentage of steatosis of the hepatic biopsy and the amplitude of the last 40 ms of average QRS (P = 0.04), the duration of the terminal low amplitude QRS signal (P = 0.05), and the number of positive criteria of late potentials (P = 0.02).

CONCLUSIONS

Chronic drinking sufficient to cause steatosis is associated with positive findings on the signal averaged ECG.