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Objective: To study the characteristics of patients with HIV and COVID-19 co-infection. Methods: Retrospective collection of data of people with HIV admitted with COVID-19, from medical record section of the hospital. We studied the clinical features, biochemical markers, radiological reports and treatment records of 5 patients admitted in our tertiary care hospital with a positive RT PCR test for COVID 19. We noted in particular the details of duration of HIV diagnosis, latest available CD4 counts, Antiretroviral therapy and adherence to treatment. Results: All patients were diagnosed with HIV for more than ve years and were varyingly adherent to the Antiretroviral therapy. Patient with lowest CD4 count (67) had full recovery whereas patient with CD4 of 160 succumbed. Commonest associated comorbidity was Diabetes Mellites. Patient 1 had mild COVID illness. Patient 2 succumbed to severe COVID whereas moderate to severe COVID was seen in patients 3 to 5. Elevation of inammatory markers like ferritin, D dimer, IL-6 were seen in patients with moderate to severe illness. Four patients were discharged without any complications. Conclusion: Poorly controlled HIV did not translate to poor outcome in our retrospective case series. Larger studies of Indian population with HIV and COVID-19 coinfection are needed to understand the relationship of viral load, inammatory markers and comorbidities with the disease outcome.

OBJECTIVE: To determine prevalence of methylenetetrahydrofolate reductase (MTHFR) mutations in apparently healthy individuals residing in Mumbai and patients with deep vein thrombosis (DVT) and coronary artery disease (CAD) and to correlate these polymorphisms with homocysteine (Hcy) levels. MATERIALS AND METHODS: This case–control study was initiated after receiving ethical approval and following the participant's written consent. One hundred and twenty unmatched healthy volunteers and 240 patients with arterial and venous thrombosis were enrolled. The prevalence of C677T and A1298C MTHFR mutations was detected using polymerase chain reaction-restriction fragment length polymorphism technique. Serum Hcy concentration and lipid levels were determined using biochemical kits. RESULTS: Allele frequency of 677T was 7%, 15%, and 14% in healthy controls, DVT, and CAD patients, respectively, while for 1298C allele, it was 31%, 33%, and 29%, respectively. The lipid markers in CAD patients were significantly low in comparison to the controls while the Hcy level in patients with thrombosis was higher in comparison with the controls. Highest Hcy levels were observed in participants with TT genotype followed by CT genotype and CC genotype in all the three groups. A higher risk of raised Hcy levels was seen in the variants (CT + TT) as compared to CC genotype in DVT (odds ratio [OR] = 3.39, 95% confidence interval [CI] = 1.39–8.2,P < 0.01) and CAD (OR = 21.67, 95%CI = 4.87–96.47,P < 0.0001). The risk observed for A1298C was 2.28 and 2.12 times higher in variants (AC + CC) of both DVT and CAD (OR = 2.28, 95%CI = 1.09–4.75 and OR = 2.12, 95%CI = 1.02–4.40, respectively). CONCLUSIONS: The prevalence of variants was more in thrombosis patients as compared to unmatched controls. Our study highlights the fact that MTHFR C677T polymorphism as compared to A1298C significantly affects Hcy levels in patients with thrombosis indicating that patients with mutant variants are at higher risk of rapid progression of their disease condition.

Background: Measurement of Carotid Intima Media Thickness (CIMT) by carotid doppler is a non-invasive, safe and inexpensive investigation. CIMT may predict ischaemic stroke. However, the data about the usefulness of CIMT as a predictor in Indian scenario is relatively less. The primary objective of the present study was to determine utility of CIMT as a predictor of ischemic stroke. Methods: This study was a case control study carried out at a tertiary care institute. The study included fifty cases of ischaemic stroke. Fifty age and sex matched controls were selected who were not relatives of cases. Results: A detailed history of cases and controls was taken. They were subjected to routine investigations; blood sugars and lipid profile were sent. CIMT was measured by doing carotid doppler study on both sided carotid arteries. The results were analysed. Conclusions: From this study, we concluded that there is increase in CIMT in patients of ischemic stroke. Age, gender and side of the vessel had no significant effect on CIMT. It was concluded that CIMT value has a direct correlation with ischemic stroke. Thus, Carotid intima media thickness can be used as a non-invasive predictor of future ischemic stroke incidence.

Background: The association between anemia and hypothyroidism has been recognized, although the prevalence of anemia in hypothyroid patients varies widely between studies. The main objectives were to study the prevalence, type, etiology of anemia in primary hypothyroidism and to correlate severity of anemia with severity of hypothyroidism. Methods: A case control study was carried out in a tertiary care hospital. Newly diagnosed 60 overt primary hypothyroid patients and 180 euthyroid controls were evaluated for anemia. Morphological types of anemia, their etiology were studied. Severity of anemia was correlated with that of hypothyroidism. Results: Anemia was observed in 45 patients with hypothyroidism. Symptoms due to anemia were significantly higher in cases than in the anemic controls. RBC morphology showed normocytic normochromic in 39, microcytic hypochromic in 14 and macrocytic in 7 cases. Serum iron was significantly lower in the cases than in the controls. Serum anti-TPO positivity was 63.33% in cases as compared to 10% in controls. Anemia was severe in cases with high TSH. Conclusions: The prevalence of anemia was 75% which was higher than that seen in the euthyroid controls. Hypothyroid patients were more symptomatic for anemia than the controls. Normocytic normochromic type of anemia was the most common type in our study. Autoimmunity in the form of anti-TPO positivity was detected in 69% of anemic cases. Iron deficiency was observed in the cases more than in the controls. There was a statistically significant negative correlation between TSH and hemoglobin.

Background: Malaria has a wide clinical spectrum ranging from uncomplicated disease to a fatal one. The objectives were to study clinical profile of Malaria with special reference to its complications and outcome.Methods: A prospective observational study was done in a tertiary care hospital including total of 300 patients diagnosed with Vivax or Falciparum Malaria. Data on patients’ clinical details with investigations, complications, and outcome was recorded and analysed using SPSS version 17.Results: Out of 300 patients, 179 had Vivax and 121 had Falciparum Malaria. Oliguria, high coloured urine, altered sensorium, convulsion, breathlessness, bleeding was more common in Falciparum malaria. Hypoglycaemia, thrombocytopenia, renal and hepatic involvement and ALI/ARDS were also more common in falciparum group. However, ALI/ARDS was more fatal in vivax group. Complications, outcome and biochemical parameters were correlated with parasite index and the correlations were statistically significant. Out of 22 deaths, 12 patients were from falciparum and 10 were from vivax group. Most common complication leading to death was ARDS/ALI, followed by AKI, convulsion, hepatic involvement and bleeding in decreasing order in both types of Malaria. Three patients with parasitic index 5% died.Conclusions: Clinical profile of Falciparum Malaria was more complicated. Metabolic complications with multi organ involvement, ALI/ARDS and mortality were more in Falciparum Malaria. Correlation of parasitic index with complications, biochemical parameters and outcome in both the groups was statistically significant.

The aim of this study was to determine the frequencies of SNPs in the vitamin K epoxide reductase complex subunit 1 (VKORC1) and cytochrome P450 2C9 (CYP2C9) genes and their effect on warfarin dose requirement, over anticoagulation and other adverse outcomes in Indian population. A total of 145 warfarin treated patients for various clinical conditions were screened for VKORC1 and CYP2C9 gene polymorphisms by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. We found that homozygous VKORC1-1639 AA and CYP2C9 (⁎)3/(⁎)3 polymorphisms showed 100% association with risk of over anticoagulation and other adverse events. Carriers of two heterozygous variant genotypes also showed significant association with risk of over anticoagulation and bleeding. Single variant carrier patients were found to require low warfarin dose as compared to wild type (CYP2C9(⁎)1/(⁎)1 and VKORC1- 1639 GG) patients. The major impact of VKORC1 and CYP2C9 genotypes was observed in the first month of anticoagulation. A drastic variation from other Asian countries was observed in Indian population with regard to the distribution of different VKORC1 -1639 genotypes. Our results suggest that both VKORC1 and CYP2C9 genotypes showed significant impact on warfarin dose requirement, over anticoagulation in the first month of anticoagulation and number of bleeding episodes. The variation in therapeutic dosage of warfarin and the associated adverse events across different populations is due to the wide differences in the frequency of these warfarin sensitive alleles.