Chitralekha Nayak - Academia.edu (original) (raw)

Papers by Chitralekha Nayak

Indian Journal of Ophthalmology, 2021

Dear Editor, A 20‐year‐old male presented to the Physician with symptoms of fever, cough, and mal... more Dear Editor, A 20‐year‐old male presented to the Physician with symptoms of fever, cough, and malaise for 5 days. A nasopharyngeal swab was subjected to reverse transcription‐polymerase chain reaction and was found to be positive for the SARS‐CoV‐2 virus. He was started on oral vitamin C 500 mg TDS, zinc 60 mg OD, vitamin A single dose, and vitamin D single dose. He was also started on oral ivermectin 12 mg OD. The patient did not show any improvement after 2 days of treatment, and had persistence of fever and worsening of cough with excessive sputum production. He was then started on favipiravir therapy. He received 1600 mg favipiravir BD on day 1 and the morning dose of 800 mg favipiravir on day 2, when he noticed bluish discoloration of his eyes [Fig. 1]. There was no blurring of vision and the recorded visual acuity was 20/20. Slit‐lamp examination revealed bluish corneal hue. There were no pigment deposits visible, no evidence of corneal thickening or fluorescence on cobalt blue filter. The lens and anterior chamber appeared normal with clear anterior chamber contents. Gonioscopy revealed normal angles with no abnormal trabecular meshwork pigmentation and intraocular pressures of 10 and 12 on Goldmann applanation tonometer. There was no bluish discoloration of any other areas such as skin, nails, or oral and nasal mucosa. The patient also produced his old photographs wherein the color of his corneas was perfectly normal. We assumed that the bluish corneal hue could be related to favipiravir and advised the patient to stop using favipiravir immediately. It was remarkable to note that the very next day upon stopping favipiravir the patient’s corneas returned to normal color [Fig. 2].

Journal of evolution of medical and dental sciences, Apr 23, 2018

A 60-year-old farmer who is diabetic for five years presented with pyrexia of unknown origin for ... more A 60-year-old farmer who is diabetic for five years presented with pyrexia of unknown origin for one month. Fever was high grade associated with chills, dysuria and increased frequency of micturition, dull aching diffuse abdominal pain and weight loss. There was no history of rash, vomiting, altered bowel habits, cough, bleeding manifestations, altered sensorium and seizures. Patient denied history of recent travel, consumption of raw milk and contact with tuberculosis. Melioidosis, an emerging underdiagnosed infectious disease is caused by Burkholderia pseudomallei, a Gram negative bacillus commonly found in the soil of tropical countries. It is important to consider melioidosis as a differential diagnosis amongst pyrexia of unknown origin cases even in non-endemic areas for an early antibiotic treatment and prevention of relapse. [1] Almost all B. pseudomallei strains are susceptible to the first line antibiotic Ceftazidime. We report a case of culture proven melioidosis primarily resistant to ceftazidime who developed relapse at different sites in the eradication phase of treatment despite adequate course of in vitro sensitive antibiotics.

International Surgery Journal, Jul 24, 2018

Snakebite is classified by the WHO as a neglected tropical disease. Neurotoxic snake bites pose a... more Snakebite is classified by the WHO as a neglected tropical disease. Neurotoxic snake bites pose a great diagnostic challenge to the physicians in tropical and subtropical regions of the world. There is considerable variation between individual patients in the clinical manifestations following envenoming by neurotoxic snake bite. Here authors describe a rare case who presented to emergency department as acute acalculous cholecystitis following unknown neurotoxic snake bite. This acalculous cholecystitis resolved post administration of anti-snake venom. The possibility of this rare but potentially fatal complication needs to be considered in patients with snake bite and abdominal symptoms so that prompt management can prevent mortality in such patients.

International journal of basic and clinical pharmacology, Jul 22, 2017

International Journal of Research in Medical Sciences, Aug 25, 2018

This study describes a rare case of a 19-year-old girl who presented with features of subcutaneou... more This study describes a rare case of a 19-year-old girl who presented with features of subcutaneous emphysema and pneumomediastinum to the emergency department in whom further investigation revealed pulmonary and neurotuberculosis. Tuberculosis presenting as pneumomediastinum and subcutaneous emphysema is a rare, but an important entity and a better knowledge of this condition can help in the early diagnosis and adequate management of tuberculosis.

Journal of evolution of medical and dental sciences, May 11, 2017

BACKGROUND Vitamin D deficiency is widely prevalent across all ages, races, geographical regions ... more BACKGROUND Vitamin D deficiency is widely prevalent across all ages, races, geographical regions and socioeconomic strata. There is ample evidence indicating role of vitamin D in insulin secretion and insulin resistance in patients with type 2 diabetes mellitus. Evidence shows that Vitamin D deficiency can affect the glycaemic control in type 2 diabetes mellitus. Objective-To study the association between serum 25-hydroxyvitamin D levels with glycaemic control in patients of type 2 diabetes mellitus. MATERIALS AND METHODS This case series study was performed on 50 consecutive patients of type 2 diabetes mellitus of 30 to 60 years admitted in General Medicine Ward at Goa Medical College. Serum 25-hydroxyvitamin D levels were assessed using Fully Automated Chemiluminescent Immunoassay (CLIA). Patients with renal failure, type 1 diabetes, chronic illness, pregnancy, thyroid disorders and previous intake of calcium and vitamin D were excluded from the study. The relationship between serum 25-hydroxyvitamin D levels and HbA1c, fasting blood glucose and postprandial blood glucose levels was assessed. RESULTS 72% of the study population had vitamin D deficiency and 26% of the study group had insufficiency of the vitamin and the remaining 2% had normal 25-hydroxyvitamin D levels. The type 2 diabetic individuals with vitamin D deficiency showed a poor glycaemic control as evidenced by inverse relationship of serum vitamin D levels with FBSL and PPBSL values. There was inverse association between the low serum 25-hydroxyvitamin D levels and elevated HbA1c in the study population. CONCLUSION Vitamin D deficiency may be associated with impairment of glycaemic control in type 2 diabetes mellitus.

Intussusception occurring in adults is an uncommon entity unlike pediatric population and is usua... more Intussusception occurring in adults is an uncommon entity unlike pediatric population and is usually due to an underlying mechanical cause. Malignancy is the most common identified etiology in adult intussusception. Jejunal intussusception secondary to benign cause is a very rare phenomenon. We present a case of jejunal intussusception in an elderly male postoperatively diagnosed to be due to jejunal lipoma. A high index of clinical suspicion of such condition supported by computed tomography can help in preoperative diagnosis of such cases as most cases of jejunal lipomas are incidentally diagnosed during laparotomy.

BackgroundThe study was conducted to evaluate the histopathological profile of lymphadenopathy an... more BackgroundThe study was conducted to evaluate the histopathological profile of lymphadenopathy and assess its etiology. MethodObservational case series study was conducted among 100 consecutive patients based on clinical examination and constructed questionnaire. Fine needle aspiration cytology and lymph node excision biopsy was performed in all patients to evaluate the causes of lymphadenopathy.Data was Statistically analyzed using SPSS software. ResultsThe results of present study showed that 70% of the study population had cervical lymphadenopathy, while 16% of the study group had inguinal lymphadenopathy and the remaining 14% developed axillary lymphadenopathy. Tuberculosis was the most common cause of lymphadenopathy observed in 47% of participants. 26% of participants were diagnosed to have malignancy in the current study which predominantly revealed lymphadenopathy secondary to metastasis. Conclusion-The present study showed a high incidence of tuberculosis and occult maligna...

Indian Journal of Ophthalmology, 2021

Dear Editor, A 20‐year‐old male presented to the Physician with symptoms of fever, cough, and mal... more Dear Editor, A 20‐year‐old male presented to the Physician with symptoms of fever, cough, and malaise for 5 days. A nasopharyngeal swab was subjected to reverse transcription‐polymerase chain reaction and was found to be positive for the SARS‐CoV‐2 virus. He was started on oral vitamin C 500 mg TDS, zinc 60 mg OD, vitamin A single dose, and vitamin D single dose. He was also started on oral ivermectin 12 mg OD. The patient did not show any improvement after 2 days of treatment, and had persistence of fever and worsening of cough with excessive sputum production. He was then started on favipiravir therapy. He received 1600 mg favipiravir BD on day 1 and the morning dose of 800 mg favipiravir on day 2, when he noticed bluish discoloration of his eyes [Fig. 1]. There was no blurring of vision and the recorded visual acuity was 20/20. Slit‐lamp examination revealed bluish corneal hue. There were no pigment deposits visible, no evidence of corneal thickening or fluorescence on cobalt blue filter. The lens and anterior chamber appeared normal with clear anterior chamber contents. Gonioscopy revealed normal angles with no abnormal trabecular meshwork pigmentation and intraocular pressures of 10 and 12 on Goldmann applanation tonometer. There was no bluish discoloration of any other areas such as skin, nails, or oral and nasal mucosa. The patient also produced his old photographs wherein the color of his corneas was perfectly normal. We assumed that the bluish corneal hue could be related to favipiravir and advised the patient to stop using favipiravir immediately. It was remarkable to note that the very next day upon stopping favipiravir the patient’s corneas returned to normal color [Fig. 2].

International Journal of Advances in Medicine, 2021

Background: Hematological abnormalities are known to be independent predictors of morbidity and m... more Background: Hematological abnormalities are known to be independent predictors of morbidity and mortality in HIV-infected patients. The current study was conducted to evaluate the hemoglobin levels and CD4 count at the time of initiation of highly active antiretroviral therapy (HAART) of newly diagnosed HIV/AIDS patients attending ART centre at Goa Medical College.Methods: A hospital based observational retrospective study was carried out in Department of Medicine of Goa Medical College in collaboration with ART centre from October 2015 to January 2016. Patient’s relevant data about the infection was collected from patient’s treatment record card at the ART centre using preformed questionnaire.Results: The prevalence of anaemia in study participants was 66.35%. The prevalence of severe anaemia and mild-moderate anaemia was 9% and 57.3% respectively, while 33.65% of participants were not anaemic. Significant difference was observed in the prevalence of anaemia among immune deficient ...

International Journal Of Community Medicine And Public Health, 2021

Background: Despite the improved access to antiretroviral therapy (ART), India accounts for the t... more Background: Despite the improved access to antiretroviral therapy (ART), India accounts for the third largest cases of HIV in the world. Nearly 86% of reported cases are occurring in sexually active and economically productive age group (15-44 years). The current study was conducted to study the socio demographic profile of newly diagnosed HIV patients attending ART centre at Goa Medical College in Goa.Methods: A hospital based observational retrospective study was carried out in the department of Medicine of Goa Medical College in collaboration with ART centre from October 2015 to January 2016. Patient’s relevant data about the infection was collected from their treatment record card at the ART centre using preformed questionnaire.Results: In the present study out of 211 patients, male patients 112 (53.08%) outnumbered female patients 99 (46.92%). 80.56% of the study group were in the age group of 20-39 years. Although the total number of male HIV positive patients was more, there ...

International Journal of Advances in Medicine, 2021

Acute aortic thrombosis is an uncommon vascular emergency that can present with neurologic sympto... more Acute aortic thrombosis is an uncommon vascular emergency that can present with neurologic symptoms like acute paraplegia due to spinal cord ischemia. It frequently causes mortality unless appropriate diagnosis is followed immediately by proper management. Individuals with COVID-19 have coagulopathy with hyper inflammatory response which predisposes to both venous and arterial thrombotic events, especially in severe patients. We report a rare case of 63-year-old COVID-19 patient presenting as acute flaccid paraplegia with hematuria secondary to acute extensive aortic thrombus. CT scan showed bilateral COVID-19 pneumonia inspite of absence of respiratory symptoms. All patients with thrombotic events should be investigated for COVID-19 pneumonia as patients may not have typical respiratory symptoms.

International Journal of Research in Medical Sciences, 2018

This study describes a rare case of a 19 year old girl who presented with features of subcutaneou... more This study describes a rare case of a 19 year old girl who presented with features of subcutaneous emphysema and pneumomediastinum to the emergency department in whom further investigation revealed pulmonary and neurotuberculosis. Tuberculosis presenting as pneumomediastinum and subcutaneous emphysema is a rare, but an important entity and a better knowledge of this condition can help in the early diagnosis and adequate management of tuberculosis.

Journal of Evolution of Medical and Dental Sciences, 2018

A 60-year-old farmer who is diabetic for five years presented with pyrexia of unknown origin for ... more A 60-year-old farmer who is diabetic for five years presented with pyrexia of unknown origin for one month. Fever was high grade associated with chills, dysuria and increased frequency of micturition, dull aching diffuse abdominal pain and weight loss. There was no history of rash, vomiting, altered bowel habits, cough, bleeding manifestations, altered sensorium and seizures. Patient denied history of recent travel, consumption of raw milk and contact with tuberculosis. Melioidosis, an emerging underdiagnosed infectious disease is caused by Burkholderia pseudomallei, a Gram negative bacillus commonly found in the soil of tropical countries. It is important to consider melioidosis as a differential diagnosis amongst pyrexia of unknown origin cases even in non-endemic areas for an early antibiotic treatment and prevention of relapse. [1] Almost all B. pseudomallei strains are susceptible to the first line antibiotic Ceftazidime. We report a case of culture proven melioidosis primarily resistant to ceftazidime who developed relapse at different sites in the eradication phase of treatment despite adequate course of in vitro sensitive antibiotics.

International Surgery Journal, 2018

Snakebite is classified by the WHO as a neglected tropical disease. Neurotoxic snake bites pose a... more Snakebite is classified by the WHO as a neglected tropical disease. Neurotoxic snake bites pose a great diagnostic challenge to the physicians in tropical and subtropical regions of the world. There is considerable variation between individual patients in the clinical manifestations following envenoming by neurotoxic snake bite. Here authors describe a rare case who presented to emergency department as acute acalculous cholecystitis following unknown neurotoxic snake bite. This acalculous cholecystitis resolved post administration of anti-snake venom. The possibility of this rare but potentially fatal complication needs to be considered in patients with snake bite and abdominal symptoms so that prompt management can prevent mortality in such patients.

International Journal of Basic & Clinical Pharmacology, 2017

The occurrence of adverse drug reactions (ADRs) to more than one drug in quick succession can cau... more The occurrence of adverse drug reactions (ADRs) to more than one drug in quick succession can cause diagnostic dilemma to the doctor and increased burden of suffering to the patient. We present a single case report of a 23 year old female who developed rash and agranulocytosis in quick succession as ADRs to phenytoin and levetiracetam respectively. These antiepileptic drugs (AEDs) were prescribed as prophylaxis against post traumatic seizures (PTS). Hence a proper rationale for the prophylactic treatment of PTS and pharmacovigilance for early detection of adverse drug reactions is the need of the hour.

Journal of Evolution of Medical and Dental Sciences, 2017

BACKGROUND Vitamin D deficiency is widely prevalent across all ages, races, geographical regions ... more BACKGROUND Vitamin D deficiency is widely prevalent across all ages, races, geographical regions and socioeconomic strata. There is ample evidence indicating role of vitamin D in insulin secretion and insulin resistance in patients with type 2 diabetes mellitus. Evidence shows that Vitamin D deficiency can affect the glycaemic control in type 2 diabetes mellitus. Objective-To study the association between serum 25-hydroxyvitamin D levels with glycaemic control in patients of type 2 diabetes mellitus. MATERIALS AND METHODS This case series study was performed on 50 consecutive patients of type 2 diabetes mellitus of 30 to 60 years admitted in General Medicine Ward at Goa Medical College. Serum 25-hydroxyvitamin D levels were assessed using Fully Automated Chemiluminescent Immunoassay (CLIA). Patients with renal failure, type 1 diabetes, chronic illness, pregnancy, thyroid disorders and previous intake of calcium and vitamin D were excluded from the study. The relationship between serum 25-hydroxyvitamin D levels and HbA1c, fasting blood glucose and postprandial blood glucose levels was assessed. RESULTS 72% of the study population had vitamin D deficiency and 26% of the study group had insufficiency of the vitamin and the remaining 2% had normal 25-hydroxyvitamin D levels. The type 2 diabetic individuals with vitamin D deficiency showed a poor glycaemic control as evidenced by inverse relationship of serum vitamin D levels with FBSL and PPBSL values. There was inverse association between the low serum 25-hydroxyvitamin D levels and elevated HbA1c in the study population. CONCLUSION Vitamin D deficiency may be associated with impairment of glycaemic control in type 2 diabetes mellitus.

Journal of Pediatric Surgery, 2008

Abdominal cocoon is a rare cause of relative external small bowel obstruction. It is diagnosed pr... more Abdominal cocoon is a rare cause of relative external small bowel obstruction. It is diagnosed predominantly in female adolescents. Diagnosis is made incidentally at laparotomy. In the past, most patients originated from subtropical regions. We discussed the first patient to be diagnosed as having the said condition in the Netherlands. A preoperative diagnosis would have been facilitated by previous knowledge of the condition. An adopted female adolescent of subtropical origin presented with recurrent failure of intestinal passage at our pediatric surgery ward after referral. Preoperative workup with a contrast-enhanced small bowel passage study showed a gastric and duodenal distension and a cauliflower sign on late passage films. Explorative laparotomy was performed under suspicion of a proximal jejunal obstruction. Findings at laparotomy were characteristic of abdominal cocoon.

Indian Journal of Ophthalmology, 2021

Dear Editor, A 20‐year‐old male presented to the Physician with symptoms of fever, cough, and mal... more Dear Editor, A 20‐year‐old male presented to the Physician with symptoms of fever, cough, and malaise for 5 days. A nasopharyngeal swab was subjected to reverse transcription‐polymerase chain reaction and was found to be positive for the SARS‐CoV‐2 virus. He was started on oral vitamin C 500 mg TDS, zinc 60 mg OD, vitamin A single dose, and vitamin D single dose. He was also started on oral ivermectin 12 mg OD. The patient did not show any improvement after 2 days of treatment, and had persistence of fever and worsening of cough with excessive sputum production. He was then started on favipiravir therapy. He received 1600 mg favipiravir BD on day 1 and the morning dose of 800 mg favipiravir on day 2, when he noticed bluish discoloration of his eyes [Fig. 1]. There was no blurring of vision and the recorded visual acuity was 20/20. Slit‐lamp examination revealed bluish corneal hue. There were no pigment deposits visible, no evidence of corneal thickening or fluorescence on cobalt blue filter. The lens and anterior chamber appeared normal with clear anterior chamber contents. Gonioscopy revealed normal angles with no abnormal trabecular meshwork pigmentation and intraocular pressures of 10 and 12 on Goldmann applanation tonometer. There was no bluish discoloration of any other areas such as skin, nails, or oral and nasal mucosa. The patient also produced his old photographs wherein the color of his corneas was perfectly normal. We assumed that the bluish corneal hue could be related to favipiravir and advised the patient to stop using favipiravir immediately. It was remarkable to note that the very next day upon stopping favipiravir the patient’s corneas returned to normal color [Fig. 2].

Journal of evolution of medical and dental sciences, Apr 23, 2018

A 60-year-old farmer who is diabetic for five years presented with pyrexia of unknown origin for ... more A 60-year-old farmer who is diabetic for five years presented with pyrexia of unknown origin for one month. Fever was high grade associated with chills, dysuria and increased frequency of micturition, dull aching diffuse abdominal pain and weight loss. There was no history of rash, vomiting, altered bowel habits, cough, bleeding manifestations, altered sensorium and seizures. Patient denied history of recent travel, consumption of raw milk and contact with tuberculosis. Melioidosis, an emerging underdiagnosed infectious disease is caused by Burkholderia pseudomallei, a Gram negative bacillus commonly found in the soil of tropical countries. It is important to consider melioidosis as a differential diagnosis amongst pyrexia of unknown origin cases even in non-endemic areas for an early antibiotic treatment and prevention of relapse. [1] Almost all B. pseudomallei strains are susceptible to the first line antibiotic Ceftazidime. We report a case of culture proven melioidosis primarily resistant to ceftazidime who developed relapse at different sites in the eradication phase of treatment despite adequate course of in vitro sensitive antibiotics.

International Surgery Journal, Jul 24, 2018

Snakebite is classified by the WHO as a neglected tropical disease. Neurotoxic snake bites pose a... more Snakebite is classified by the WHO as a neglected tropical disease. Neurotoxic snake bites pose a great diagnostic challenge to the physicians in tropical and subtropical regions of the world. There is considerable variation between individual patients in the clinical manifestations following envenoming by neurotoxic snake bite. Here authors describe a rare case who presented to emergency department as acute acalculous cholecystitis following unknown neurotoxic snake bite. This acalculous cholecystitis resolved post administration of anti-snake venom. The possibility of this rare but potentially fatal complication needs to be considered in patients with snake bite and abdominal symptoms so that prompt management can prevent mortality in such patients.

International journal of basic and clinical pharmacology, Jul 22, 2017

International Journal of Research in Medical Sciences, Aug 25, 2018

This study describes a rare case of a 19-year-old girl who presented with features of subcutaneou... more This study describes a rare case of a 19-year-old girl who presented with features of subcutaneous emphysema and pneumomediastinum to the emergency department in whom further investigation revealed pulmonary and neurotuberculosis. Tuberculosis presenting as pneumomediastinum and subcutaneous emphysema is a rare, but an important entity and a better knowledge of this condition can help in the early diagnosis and adequate management of tuberculosis.

Journal of evolution of medical and dental sciences, May 11, 2017

BACKGROUND Vitamin D deficiency is widely prevalent across all ages, races, geographical regions ... more BACKGROUND Vitamin D deficiency is widely prevalent across all ages, races, geographical regions and socioeconomic strata. There is ample evidence indicating role of vitamin D in insulin secretion and insulin resistance in patients with type 2 diabetes mellitus. Evidence shows that Vitamin D deficiency can affect the glycaemic control in type 2 diabetes mellitus. Objective-To study the association between serum 25-hydroxyvitamin D levels with glycaemic control in patients of type 2 diabetes mellitus. MATERIALS AND METHODS This case series study was performed on 50 consecutive patients of type 2 diabetes mellitus of 30 to 60 years admitted in General Medicine Ward at Goa Medical College. Serum 25-hydroxyvitamin D levels were assessed using Fully Automated Chemiluminescent Immunoassay (CLIA). Patients with renal failure, type 1 diabetes, chronic illness, pregnancy, thyroid disorders and previous intake of calcium and vitamin D were excluded from the study. The relationship between serum 25-hydroxyvitamin D levels and HbA1c, fasting blood glucose and postprandial blood glucose levels was assessed. RESULTS 72% of the study population had vitamin D deficiency and 26% of the study group had insufficiency of the vitamin and the remaining 2% had normal 25-hydroxyvitamin D levels. The type 2 diabetic individuals with vitamin D deficiency showed a poor glycaemic control as evidenced by inverse relationship of serum vitamin D levels with FBSL and PPBSL values. There was inverse association between the low serum 25-hydroxyvitamin D levels and elevated HbA1c in the study population. CONCLUSION Vitamin D deficiency may be associated with impairment of glycaemic control in type 2 diabetes mellitus.

Intussusception occurring in adults is an uncommon entity unlike pediatric population and is usua... more Intussusception occurring in adults is an uncommon entity unlike pediatric population and is usually due to an underlying mechanical cause. Malignancy is the most common identified etiology in adult intussusception. Jejunal intussusception secondary to benign cause is a very rare phenomenon. We present a case of jejunal intussusception in an elderly male postoperatively diagnosed to be due to jejunal lipoma. A high index of clinical suspicion of such condition supported by computed tomography can help in preoperative diagnosis of such cases as most cases of jejunal lipomas are incidentally diagnosed during laparotomy.

BackgroundThe study was conducted to evaluate the histopathological profile of lymphadenopathy an... more BackgroundThe study was conducted to evaluate the histopathological profile of lymphadenopathy and assess its etiology. MethodObservational case series study was conducted among 100 consecutive patients based on clinical examination and constructed questionnaire. Fine needle aspiration cytology and lymph node excision biopsy was performed in all patients to evaluate the causes of lymphadenopathy.Data was Statistically analyzed using SPSS software. ResultsThe results of present study showed that 70% of the study population had cervical lymphadenopathy, while 16% of the study group had inguinal lymphadenopathy and the remaining 14% developed axillary lymphadenopathy. Tuberculosis was the most common cause of lymphadenopathy observed in 47% of participants. 26% of participants were diagnosed to have malignancy in the current study which predominantly revealed lymphadenopathy secondary to metastasis. Conclusion-The present study showed a high incidence of tuberculosis and occult maligna...

Indian Journal of Ophthalmology, 2021

Dear Editor, A 20‐year‐old male presented to the Physician with symptoms of fever, cough, and mal... more Dear Editor, A 20‐year‐old male presented to the Physician with symptoms of fever, cough, and malaise for 5 days. A nasopharyngeal swab was subjected to reverse transcription‐polymerase chain reaction and was found to be positive for the SARS‐CoV‐2 virus. He was started on oral vitamin C 500 mg TDS, zinc 60 mg OD, vitamin A single dose, and vitamin D single dose. He was also started on oral ivermectin 12 mg OD. The patient did not show any improvement after 2 days of treatment, and had persistence of fever and worsening of cough with excessive sputum production. He was then started on favipiravir therapy. He received 1600 mg favipiravir BD on day 1 and the morning dose of 800 mg favipiravir on day 2, when he noticed bluish discoloration of his eyes [Fig. 1]. There was no blurring of vision and the recorded visual acuity was 20/20. Slit‐lamp examination revealed bluish corneal hue. There were no pigment deposits visible, no evidence of corneal thickening or fluorescence on cobalt blue filter. The lens and anterior chamber appeared normal with clear anterior chamber contents. Gonioscopy revealed normal angles with no abnormal trabecular meshwork pigmentation and intraocular pressures of 10 and 12 on Goldmann applanation tonometer. There was no bluish discoloration of any other areas such as skin, nails, or oral and nasal mucosa. The patient also produced his old photographs wherein the color of his corneas was perfectly normal. We assumed that the bluish corneal hue could be related to favipiravir and advised the patient to stop using favipiravir immediately. It was remarkable to note that the very next day upon stopping favipiravir the patient’s corneas returned to normal color [Fig. 2].

International Journal of Advances in Medicine, 2021

Background: Hematological abnormalities are known to be independent predictors of morbidity and m... more Background: Hematological abnormalities are known to be independent predictors of morbidity and mortality in HIV-infected patients. The current study was conducted to evaluate the hemoglobin levels and CD4 count at the time of initiation of highly active antiretroviral therapy (HAART) of newly diagnosed HIV/AIDS patients attending ART centre at Goa Medical College.Methods: A hospital based observational retrospective study was carried out in Department of Medicine of Goa Medical College in collaboration with ART centre from October 2015 to January 2016. Patient’s relevant data about the infection was collected from patient’s treatment record card at the ART centre using preformed questionnaire.Results: The prevalence of anaemia in study participants was 66.35%. The prevalence of severe anaemia and mild-moderate anaemia was 9% and 57.3% respectively, while 33.65% of participants were not anaemic. Significant difference was observed in the prevalence of anaemia among immune deficient ...

International Journal Of Community Medicine And Public Health, 2021

Background: Despite the improved access to antiretroviral therapy (ART), India accounts for the t... more Background: Despite the improved access to antiretroviral therapy (ART), India accounts for the third largest cases of HIV in the world. Nearly 86% of reported cases are occurring in sexually active and economically productive age group (15-44 years). The current study was conducted to study the socio demographic profile of newly diagnosed HIV patients attending ART centre at Goa Medical College in Goa.Methods: A hospital based observational retrospective study was carried out in the department of Medicine of Goa Medical College in collaboration with ART centre from October 2015 to January 2016. Patient’s relevant data about the infection was collected from their treatment record card at the ART centre using preformed questionnaire.Results: In the present study out of 211 patients, male patients 112 (53.08%) outnumbered female patients 99 (46.92%). 80.56% of the study group were in the age group of 20-39 years. Although the total number of male HIV positive patients was more, there ...

International Journal of Advances in Medicine, 2021

Acute aortic thrombosis is an uncommon vascular emergency that can present with neurologic sympto... more Acute aortic thrombosis is an uncommon vascular emergency that can present with neurologic symptoms like acute paraplegia due to spinal cord ischemia. It frequently causes mortality unless appropriate diagnosis is followed immediately by proper management. Individuals with COVID-19 have coagulopathy with hyper inflammatory response which predisposes to both venous and arterial thrombotic events, especially in severe patients. We report a rare case of 63-year-old COVID-19 patient presenting as acute flaccid paraplegia with hematuria secondary to acute extensive aortic thrombus. CT scan showed bilateral COVID-19 pneumonia inspite of absence of respiratory symptoms. All patients with thrombotic events should be investigated for COVID-19 pneumonia as patients may not have typical respiratory symptoms.

International Journal of Research in Medical Sciences, 2018

This study describes a rare case of a 19 year old girl who presented with features of subcutaneou... more This study describes a rare case of a 19 year old girl who presented with features of subcutaneous emphysema and pneumomediastinum to the emergency department in whom further investigation revealed pulmonary and neurotuberculosis. Tuberculosis presenting as pneumomediastinum and subcutaneous emphysema is a rare, but an important entity and a better knowledge of this condition can help in the early diagnosis and adequate management of tuberculosis.

Journal of Evolution of Medical and Dental Sciences, 2018

A 60-year-old farmer who is diabetic for five years presented with pyrexia of unknown origin for ... more A 60-year-old farmer who is diabetic for five years presented with pyrexia of unknown origin for one month. Fever was high grade associated with chills, dysuria and increased frequency of micturition, dull aching diffuse abdominal pain and weight loss. There was no history of rash, vomiting, altered bowel habits, cough, bleeding manifestations, altered sensorium and seizures. Patient denied history of recent travel, consumption of raw milk and contact with tuberculosis. Melioidosis, an emerging underdiagnosed infectious disease is caused by Burkholderia pseudomallei, a Gram negative bacillus commonly found in the soil of tropical countries. It is important to consider melioidosis as a differential diagnosis amongst pyrexia of unknown origin cases even in non-endemic areas for an early antibiotic treatment and prevention of relapse. [1] Almost all B. pseudomallei strains are susceptible to the first line antibiotic Ceftazidime. We report a case of culture proven melioidosis primarily resistant to ceftazidime who developed relapse at different sites in the eradication phase of treatment despite adequate course of in vitro sensitive antibiotics.

International Surgery Journal, 2018

Snakebite is classified by the WHO as a neglected tropical disease. Neurotoxic snake bites pose a... more Snakebite is classified by the WHO as a neglected tropical disease. Neurotoxic snake bites pose a great diagnostic challenge to the physicians in tropical and subtropical regions of the world. There is considerable variation between individual patients in the clinical manifestations following envenoming by neurotoxic snake bite. Here authors describe a rare case who presented to emergency department as acute acalculous cholecystitis following unknown neurotoxic snake bite. This acalculous cholecystitis resolved post administration of anti-snake venom. The possibility of this rare but potentially fatal complication needs to be considered in patients with snake bite and abdominal symptoms so that prompt management can prevent mortality in such patients.

International Journal of Basic & Clinical Pharmacology, 2017

The occurrence of adverse drug reactions (ADRs) to more than one drug in quick succession can cau... more The occurrence of adverse drug reactions (ADRs) to more than one drug in quick succession can cause diagnostic dilemma to the doctor and increased burden of suffering to the patient. We present a single case report of a 23 year old female who developed rash and agranulocytosis in quick succession as ADRs to phenytoin and levetiracetam respectively. These antiepileptic drugs (AEDs) were prescribed as prophylaxis against post traumatic seizures (PTS). Hence a proper rationale for the prophylactic treatment of PTS and pharmacovigilance for early detection of adverse drug reactions is the need of the hour.

Journal of Evolution of Medical and Dental Sciences, 2017

BACKGROUND Vitamin D deficiency is widely prevalent across all ages, races, geographical regions ... more BACKGROUND Vitamin D deficiency is widely prevalent across all ages, races, geographical regions and socioeconomic strata. There is ample evidence indicating role of vitamin D in insulin secretion and insulin resistance in patients with type 2 diabetes mellitus. Evidence shows that Vitamin D deficiency can affect the glycaemic control in type 2 diabetes mellitus. Objective-To study the association between serum 25-hydroxyvitamin D levels with glycaemic control in patients of type 2 diabetes mellitus. MATERIALS AND METHODS This case series study was performed on 50 consecutive patients of type 2 diabetes mellitus of 30 to 60 years admitted in General Medicine Ward at Goa Medical College. Serum 25-hydroxyvitamin D levels were assessed using Fully Automated Chemiluminescent Immunoassay (CLIA). Patients with renal failure, type 1 diabetes, chronic illness, pregnancy, thyroid disorders and previous intake of calcium and vitamin D were excluded from the study. The relationship between serum 25-hydroxyvitamin D levels and HbA1c, fasting blood glucose and postprandial blood glucose levels was assessed. RESULTS 72% of the study population had vitamin D deficiency and 26% of the study group had insufficiency of the vitamin and the remaining 2% had normal 25-hydroxyvitamin D levels. The type 2 diabetic individuals with vitamin D deficiency showed a poor glycaemic control as evidenced by inverse relationship of serum vitamin D levels with FBSL and PPBSL values. There was inverse association between the low serum 25-hydroxyvitamin D levels and elevated HbA1c in the study population. CONCLUSION Vitamin D deficiency may be associated with impairment of glycaemic control in type 2 diabetes mellitus.

Journal of Pediatric Surgery, 2008

Abdominal cocoon is a rare cause of relative external small bowel obstruction. It is diagnosed pr... more Abdominal cocoon is a rare cause of relative external small bowel obstruction. It is diagnosed predominantly in female adolescents. Diagnosis is made incidentally at laparotomy. In the past, most patients originated from subtropical regions. We discussed the first patient to be diagnosed as having the said condition in the Netherlands. A preoperative diagnosis would have been facilitated by previous knowledge of the condition. An adopted female adolescent of subtropical origin presented with recurrent failure of intestinal passage at our pediatric surgery ward after referral. Preoperative workup with a contrast-enhanced small bowel passage study showed a gastric and duodenal distension and a cauliflower sign on late passage films. Explorative laparotomy was performed under suspicion of a proximal jejunal obstruction. Findings at laparotomy were characteristic of abdominal cocoon.