Annals of the National Academy of Medical Sciences (India)
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Editor: Dr. Sanjeev Misra
ISSN: 2454-5635
Frequency: Quarterly
Language: English
Open Access Peer-reviewed journal
Web site: https://annals-nams.in
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Item Celiacomesenteric trunk � A not so common variation(National Academy of Medical Sciences, 2024-10) Panwar, R; Nair, AS; Athindranath, T; Adibatti, M; Krishnamurthy, A.The Coeliac trunk is the first ventral branch of the abdominal aorta and is the artery of the foregut, which supplies the derivatives of the foregut i.e., oesophagus, stomach, liver, gallbladder, pancreas, and the second part of the duodenum, up to the level of the opening of the major duodenal papilla. The superior mesenteric artery is the next branch of the abdominal aorta, which arises most commonly at the level of the first lumbar vertebra and supplies embryonic derivatives of the midgut i.e., from the second part of the duodenum (below the level of major duodenal papilla) to the proximal two-thirds of the transverse colon. Sometimes coeliac trunk and superior mesenteric artery arise as a common celiacomesenteric trunk. The embryological basis of celiacomesenteric trunk is discussed in the current case report. Also, the clinical significance of celiacomesenteric trunk in various conditions is described. During complex interventional procedures, this type of variation must be looked at carefully in radiological images to reduce the chances of postoperative complications.Item Osteocartilaginous choristoma of palatine tonsil: A rare entity(National Academy of Medical Sciences, 2024-10) Batra, A; Dhingra, S; Pujani, M; Khandelwal, A; Singh, K.Choristoma is the presence of normal tissue in an abnormal anatomical location. The presence of mature cartilage in the tonsil represents a choristoma as it is not a normal constituent of the tonsil and is a very rare entity. More than 70% of lingual choristomas occur in females; the tongue is the most common site, accounting for 80% of the cases. Osseous choristoma of the tongue is a rather rare entity, with less than 100 cases reported in the literature. We hereby report an osteocartilaginous choristoma of the palatine tonsil in a 42-year-old male patient who presented with a sore throat and difficulty in swallowing, for which he underwent tonsillectomy. Choristoma was an incidental discovery. Histopathology features were consistent with chronic tonsillitis along with incidental occurrence of hyaline cartilage and bone. As choristoma is a benign tumor that usually does not require any further treatment after simple excision, therefore no further treatment was given. The patient is currently under a 2- year follow-up and does not show any signs of recurrence. This case creates awareness about this rare entity among pathologists and clinicians so that overzealous and unnecessary treatment is avoided.Item DPI: A paradigm shift from nebulizers to dry powder inhalers(National Academy of Medical Sciences, 2024-10) Patil, PS; Mahajan, HS.Drug delivery to pulmonary routes was once considered a challenging task. The emergence of inhalation therapy paved the way for drug delivery to the lungs. With various advances in inhalation therapy, modern-age drug delivery systems include nebulizers, pressurized metereddose inhalers, and dry powder inhalers (DPIs). The following review discusses the development stages of DPIs and also gives an insight into the current formulation aspects of DPI, animal models used for evaluation of drug release parameters, and the Anderson cascade impactor and its possible correlation with human respiratory tract with regards to drug deposition and particle size. Today, DPIs have brought about a revolution in drug delivery to lungs, and also offer more advantages with regards to consistency of dose delivered, stability, and ease of administration. Dry powders have been extensively used in the treatment of asthma and various other respiratory disorders. With the introduction of nanoformulations, a wide sector of researchers is working toward developing DPIs that may be used to target diseases like lung cancer.Item Association of circulatory chemerin levels with the severity of pre-eclampsia: A systematic review and bootstrapped meta-analysis(National Academy of Medical Sciences, 2024-10) Varikasuvu, SR; Madhuri, M; Ali, A; Gowtham, K; Jegatheesan, J; Ranjan, A; Kumar, A; Kumari, B; Tiwari, M; Sharma, S.Introduction: This study presents a systematic review and meta-analysis to investigate the association between circulating chemerin levels and the severity of preeclampsia (PE). Material and Methods: A thorough search was conducted across multiple databases, including PubMed/MEDLINE, SCOPUS, and the Cochrane Library, up to March 31, 2024, focusing on observational studies that compared chemerin levels in patients with severe versus mild PE. Two independent reviewers extracted mean and standard deviation (SD) values of chemerin levels from these studies. The quality and risk of bias of the included studies were assessed using the Newcastle朞ttawa Scale. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated to evaluate the difference in chemerin levels between severe and mild PE groups. Sensitivity analyses were performed to address heterogeneity and ensure the reliability of the findings. Additionally, a bootstrapped meta-analysis with 1,000 and 10,000 simulations was conducted to further validate the results. Results: Six observational studies were included in the analysis. The findings revealed that patients with severe PE had significantly higher chemerin levels compared to those with mild PE (SMD 1.55, 95% CI 0.67�43, p < 0.0001). The bootstrapped meta-analysis supported the accuracy of these findings (SMD = 1.54, CI = 0.74�38). No publication bias was identified using Begg抯 and Egger抯 tests, and the sensitivity analysis confirmed the robustness of the results. Conclusion: This meta-analysis provides compelling evidence that chemerin levels are significantly elevated in patients with severe PE compared to those with mild PE. Further research is warranted to investigate the potential of circulating chemerin as a diagnostic marker for PE severity.Item Modulation of sleep quality, cardiac autonomic activity, and cognition by yoga in medical students(National Academy of Medical Sciences, 2024-10) Mishra, P; Singh, A; Agarwal, P; Mathur, MK; Bhandari, B.Objectives: The disturbed sleep quality among medical students due to their hectic schedule may negatively impact the cognition, consequently affecting their academic performance. With the hypothesis that short duration of simple yogic exercises may improve sleep quality and heart rate variability (HRV), and thus may improve cognitive abilities, the study aims to evaluate the outcome of short duration yoga training on HRV, cognition, and sleep in medical students. Material and Methods: The participants of the study were young and apparently healthy medical students. The study commenced after the Institutional Scientific Re- search and Ethics Committee approval. The informed consent was taken from all the participants in writing. All parameters (height, weight, age, body mass index [BMI], systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR]) along with HRV, sleep quality (using Pittsburgh Sleep Quality Index [PSQI]), and cognitive ability (using Trail Making Tests Parts A & B [TMTs-A&B]) were assessed in the participants at baseline. Thereaf- ter, the students practiced yoga (asanas, pranayama, and meditation) under supervision of a yoga instructor and a faculty for the duration of one hour every day for six weeks. Measurements were repeated after six weeks. Depending on the normality of data and data distribution, the comparison was done using Wilcoxon Signed Rank Test or dependent samples t-test. The level of significance was kept as p < 0.05. Results: Following six weeks of yoga sessions, a significant improvement in the high frequency power normalized unit (HFnu) and total power in comparison to baseline values was observed: 53.25� 10.14 versus 59.57 � 9.61 and 3238 � 1133 versus 3473 � 1130, respectively. Significant difference at six weeks between baseline and post yoga values was observed in TMT-A (30.16 � 5.04 vs 19.84 � 2.76) and TMT-B (69.96 � 12.99 vs 49.24 � 10.99). Sleep quality also improved significantly after yoga sessions (baseline PSQI score of 10.68 � 1.79 and post-PSQI score of 4.12 � 1.67). Conclusion: It was concluded that one hour of supervised yoga session every day for six weeks can improve HRV, sleep quality, and cognitive ability among medical students. Medical students should practice yoga regularly to improve cognitive function and sleep and to reduce cardiovascular morbidity.Item Recounting COVID-19 associated complement-mediated coagulopathies: Triggers and controls(National Academy of Medical Sciences, 2024-10) Lata, P; Madhuri, M; Ali, A; Kumari, B; Tiwari, M; Kumar, A; Hajela, K; Bhushan, D; Sharma, S.The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to a global health crisis, prompting extensive research into its pathogenesis and potential therapeutic interventions. One area of increasing interest is the interaction between SARS-CoV-2 and the complement system, a crucial component of innate immunity. This review explores the intricate relationship between COVID-19 and the complement system, shedding light on how the virus exploits and manipulates the complement components to induce inflammatory responses leading to coagulopathies. The activation of the complement pathway simultaneously activates the coagulation cascade due to the presence of common substrates of mannan-binding serine proteases of the lectin complement system in the coagulation pathway. This cross-talk between the components of the complement and coagulation system further aggravates the dysregulation of immune responses, contributing to the cytokine storm observed in severe COVID-19 cases. A comprehensive understanding of this crosstalk is crucial for developing targeted therapeutic strategies to mitigate the hyperinflammatory state associated with severe disease. Understandings into the molecular mechanisms governing this interaction may pave the way for the development of novel antiviral diagnostics and therapies based on immunomodulatory interventions, offering better management for such cases.Item Bacterial etiology among diarrheal cases(National Academy of Medical Sciences, 2024-10) Kashyap, A; Malakar, M; Dutta, I.Objectives: The main objective of this article was to check the bacterial etiology to find out the routes of infection, which might help with control strat- egies. As Nalbari is one of the most common flood-affected districts in Assam, India, we chose Nalbari district as our study area. The socioeconomic factor enhances the transmission of bacteria easily, as every year during floods, pictures of water from neighboring hilly states or countries (e.g., Bhu- tan)梤ain, waterlogging, and more梐re seen. Material and Methods: Stool samples or rectal swabs were collected from the patients who had reported to the District Public Health Laboratory(D- PHL) with acute diarrheal disease in Nalbari. Patients or their attendant's consent was collected prior to collecting samples. Samples were processed for culture, gram stain microscopy, and biochemical tests to isolate the organism. Results: Test results showed Escherichia coli (E. coli) 40.95%, Salmonella 2.86%, Shigella 1.42%, and Campylobacter 0.48%. No other bacteria were iso- lated during the study period. Maximum cases were reported during the rainy season. Conclusion: E. coli can transmit through fecal-oral means; Salmonella through contaminated food, water, contact with infected people/animals, and so on; Shigella through fecal-oral, contaminated food, water, oral-anal sexual routes, and more; and Campylobacter through contaminated or raw food, milk, water, and so on. This study concludes that water can easily transmit bacteria to other people. Health hygiene, economic condition, living behavior, awareness, and administration抯 activities all might play an important role in minimizing this burden. Making plans prior to flood by administration and more research studies can help in controlling this disease burden.Item A comparative study of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in bipolar mania and schizophrenia(National Academy of Medical Sciences, 2024-01) Goyal, MK; Yadav, KS; Solanki, RKObjectives: The role of immunological disturbance in bipolar disorder (BD) and schizophrenia has been highlighted by some studies. There are few studies available that compared the inflammatory markers between schizophrenia and BD, but only one study demonstrated the difference in terms of neutrophil/lymphocyte ratio (NLR) and Platelet/lymphocyte ratio (PLR) between them. So this study was conducted to compare the NLR and PLR values among schizophrenia, bipolar mania, and healthy controls in order to find out a potential biomarker for these disorders. Material and Methods: Eighty consecutive patients suffering from bipolar mania, 80 suffering from schizophrenia, and 80 healthy controls were recruited in the psychiatric center situated at a tertiary care hospital. Blood samples of all groups were transferred to the laboratory for complete blood count analysis. Thereafter, all the groups were compared by applying proper statistics. Results: Significant higher level of neutrophil count and NLR value was seen in both bipolar mania and schizophrenia groups compared to healthy controls. There was no difference observed between schizophrenia and the bipolar mania group regarding NLR, PLR, neutrophils, lymphocytes, and platelets values. Conclusion: NLR has appeared as a potential marker in our study, and it reflects a state of low-grade inflammation in both schizophrenia and bipolar mania. BD and schizophrenia have been considered as part of one continuum, which is also supported by the findings of our study. These markers can help in the prognosis and treatment of at least a subsection of patients and also are inexpensive and easy to assess.Item Risk stratification in multiple myeloma – A review and update(National Academy of Medical Sciences, 2024-04) Das, N; Gupta, RMultiple myeloma (MM) is a hematological malignancy of plasma cell origin with a prevalence rate of 1% and 10% of all cancers and hematopoietic malignancies, respectively. Though the median survival time has improved dramatically in the patients diagnosed with MM with the administration of novel therapeutic agents, the disease, by and large, remains incurable with frequent progression and relapses. In the recent past, an increased understanding of MM pathogenesis has opened facets for improved diagnosis, prognosis, and response assessment in patients diagnosed with MM. This review focuses on the various laboratory and clinical features used to stratify the MM patients into high vs. low-risk groups. Furthermore, it also highlights the role of artificial intelligence-based innovative research tools for risk stratification and prognostication in MM patients.Item Diminished LC3 expression with unchanged Beclin 1 levels in right atrial appendage tissue of diabetic patients undergoing coronary artery bypass graf(National Academy of Medical Sciences, 2024-01) Rajendran, RS; Jayakumari, NR; Pillai, VV; Karunakaran, J; Gopala, SType 2 diabetes potentiates the risk of heart failure. A vital physiologic process, autophagy, may be impaired in the diabetic heart. The purpose of the present work was to explore the autophagic status in the human diabetic heart. Techniques like immunohistochemistry and western blotting were employed to examine the expression of some of the important proteins involved in autophagic machinery. Our brief study reports, for the first time, evidence of decreased cardiac autophagic levels in diabetic patients.Item Recovery of memory decline during aging - role of epigenetics(National Academy of Medical Sciences, 2024-04) Mishra, E; Thakur, MKAging is a natural phenomenon associated with the accumulation of multiple alterations, including memory loss. Such deterioration of memory is based on the susceptibility of specific brain regions and the disorders that coincide with aging in those areas. Previous findings suggest that the optimal expression of synaptic plasticity-related genes is essential for memory formation and consolidation. Epigenetic modifications are one of the most crucial factors that cause memory deterioration by inducing the differential expression of synaptic plasticity-related genes. Understanding the fundamental cause of cognitive alterations that arise with aging is very essential for the development of therapeutic and/or preventive approaches. Several strategies have been employed to restore or reverse the memory decline caused by age-associated epigenetic alterations. The present article emphasizes the role of epigenetic alterations caused by histone modifications, DNA methylation, and non-coding ribonucleic acids (RNAs) on memory during aging. Also, we highlight the mechanistic switches of brain aging, including physical exercise, nutraceuticals, epigenetic modifiers, modulators of non-coding RNAs, and associated targets for therapeutic interventions. The emerging field of neuropharmacology and pharmacoepigenomics provides evidence that small drug molecules are currently employed to treat memory loss associated with aging, particularly by targeting epigenetic systems like DNA methylation, chromatin remodeling, histone modifications, and small non-coding RNAs. Therefore, targeting epigenetic modifications could be a potential therapeutic approach for the improvement of synaptic plasticity, neuronal activities, memory, and other brain functions during aging.Item Rifampicin-induced thrombocytopenia in a patient with abdominal tuberculosis(National Academy of Medical Sciences, 2024-01) Boddu, R; Sharma, A; Mishra, K; Kumar, SMost anti-tubercular drugs are relatively safe, but adverse reactions are not uncommon. Rifampicin is one of the most effective and widely used antituberculosis drugs. Adverse effects due to rifampicin are not uncommon and the patients usually have skin rash, gastrointestinal disturbances, and hepatotoxicity. Rarely, the patients may also have allergic and autoimmune manifestations, which may include life-threatening thrombocytopenia. A high index of suspicion and careful evaluation for temporal association with the suspected drug are required to diagnose drug-induced immune thrombocytopenia. We present a case of rifampicin-induced thrombocytopenia; though relatively rare, it needs attention.Item A review of the adverse impacts of allergic rhinitis on health-related quality of life and its evaluation(National Academy of Medical Sciences, 2024-04) Srivastava, P; Patil, SAIt has been proven that successfully treating allergic rhinitis (AR) with non-sedating antihistamines, intranasal corticosteroids, and other widely used, approved treatments results in improvements in health-related quality of-life questionnaires by incorporating health-related quality of life measures in clinical trials. Analyze therapeutic modalities that provide reliable and practical solutions to minimize the effects of this illness. The effects of AR on people’s health and quality of life should be examined by doctors. Better patient-provider communication and a deeper comprehension of AR may help with the treatment of this illness.Item A narrative review on rebound acid hypersecretion due to long-term use of proton pump inhibitors(National Academy of Medical Sciences, 2024-04) Balivada, V; Koraykar, RMObjectives: Proton pump inhibitors (PPIs) are the most commonly used drugs to reduce hyperacidity. The usage of PPIs reduces the secretion of gastric juice; their prolonged usage results in gastric acid suppression with hypergastrinemia while their stoppage results in hypersecretion of gastric juice. This kind of paradoxical reaction is seen in the rebound effect of drugs. Dr. Samuel Hahnemann gave us the vital principles of homeopathy, the law of similitude, i.e., “similia similibus curentur” derived from the “Nature’s Law of Cure”. This also tells us that the primary action of medicine stimulates the dynamic expression of an organism (vital force), which results in the counteraction called secondary action by the organism. Material and Methods: Review of literature on the effects of long-term use of PPIs and rebound hypersecretion of gastric juice due to PPIs. Results: For this review article, 16 most relevant articles are selected from the search results. Thirteen systematic reviews, two randomized control trials, and one pilot study are included. Rebound acid hypersecretion (RAHS) occurs after prolonged treatment with histamine-2 blockers and PPIs, causing gastric hypoacidity and hypergastrinemia. Longer PPI durations can result in prolonged hypersecretion, with moderate hypergastrinemia and increased enterochromaffin-like (ECL) cell hyperplasia. Deprescribing PPIs is crucial to reduce RAHS and safety concerns. Long-term usage can lead to nutritional deficiencies, respiratory infections, and bone fractures. Conclusion: Homeopathic remedies have shown significant results in treating symptoms caused due to gastritis, ulcers, gastroesophageal reflux disease, etc., and further research is needed to reduce RAHS caused due to the long-term use of PPIs.Item Loss of lateral femoral condyle following sepsis of knee region in infancy: The hypothesis of vascular pathogenesis and clinical course(National Academy of Medical Sciences, 2024-07) Agarwal, A; Jethwa, RComplete loss of lateral femoral condyle of the femur following sepsis of the knee region in infancy is a well-recognized entity. The etiopathogenesis of the sequelae is poorly understood with synovial plicae and post-septic growth disturbance postulated as possible causes. Two illustrative cases are presented to elucidate the clinical effects of condylar loss in the pediatric age group.There is a typical pattern of unicondylar damage, loss of adjacent metaphysis, and metaphyseal spur in involved cases. Abnormal loading of the knee, ligament laxity, and the presence of a physeal bar contribute additionally to deformity. The deformity progression can be as rapid as 2.8 degrees per month. The lesion is most often treated by balancing the knee mechanics using osteotomies and growth modulations. The lesion progresses downhill due to the absence of lateral support of the knee joint configuration. The anatomical region supplied by the superior lateral genicular vessels closely matches with the lateral unicondylar femoral loss seen post-sepsis. A vascular etiology is therefore hypothesized for the lesion.Item Spectrum of bacterial isolates and their antibiogram in intensive care unit (ICU) of tertiary care hospital as a part of hospital acquired infection (HAI) surveillance(National Academy of Medical Sciences, 2024-07) Deb, J; Debnath, S; Bhattacharya, S; Majumdar, TObjectives: The introduction of the study discusses the prevalence of Urinary Tract Infections (UTIs) as a common hospital-acquired infection worldwide. The specific goals of the study were to isolate and identify the organisms causing UTIs, and determine their antimicrobial sensitivity patterns. Material and Methods: A total of 150 consecutive urine samples were collected over a 24 month period from selected surveillance units Medical-Surgical ICU (MICU) Respiratory ICU (RICU) Pediatric ICU (PICU). Microbiological culture, subsequent bacterial identification and antimicrobial susceptibility test were performed for the positive samples. The prevalence of the causative agents was analyzed according to the patient’s gender and age group. Results: A total of 45 uropathogens were isolated, with Enterococcus spp. being the most common at 33.3%. The study found that Nitrofurantoin antibiotic had the highest sensitivity at 77% against Enterococcus spp. The study also found that nosocomial infections lengthened hospital and intensive care unit stays, and during the surveillance period eight patients expired, who were infected by Enterococcus spp., Klebsiella pneumoniae, Enterobacter spp. and Klebsiella spp. Conclusion: The conclusion section of the study highlights that the study documented the pathogenic effect of Enterococcus spp., which was responsible for the majority of infections. This study may be useful for future studies to assess the genetic profile of the MDR gene of isolated microorganisms and to early assess the methods for detecting pathogenic organisms in clinical samples in order to save lives in critical care units. The study also suggests that Nitrofurantoin antibiotic was found to be the most effective against urinary tract isolates of Enterococcus spp.Item Six-minute walk test among silicosis patients: Its correlation with abnormal radiographic findings on chest radiograph and high resolution computed tomography scan(National Academy of Medical Sciences, 2024-07) Jalutharia, J; Dixit, R; Kuldeep, R; Goyal, M; Choudhary, M; Srivastava, KObjectives: Silicosis is one of the oldest chronic lung diseases that leads to relentless fibrotic changes in the lungs with a resultant fall in lung functions. is study was conducted to assess exercise capacity utilizing a six-minute walk test (6-MWT) among patients detected to have “simple” and “complicated” forms of silicosis. A further correlation between 6-MWT parameters and abnormal chest imaging findings was also done. Material and Methods: Silicosis diagnosis among study subjects was based on the history of exposure to occupational silica dust along with suggestive radiological findings of pneumoconiosis assessed by the trained experts. Study subjects performed the 6-MWT as per standard protocol. Chest radiological and “high resolution computed tomographic” (HRCT) abnormalities were also analyzed in each subject and compared with their 6-MWT components (distance walked in meters and oxygen desaturation occurrence, if any). Results: One hundred twelve study subjects (males 106 and females 6; mean age 44.05+10.84 years) constituted the final study population. e sixminute walk distance (6-MWD), fall in SpO2 and BORG dyspnea scale in patients with grade “0” on chest X-ray was 362.79 ± 34.2 meter, 1.28 ± 0.91% and 0.96 ± 0.59, respectively and these parameters gradually converted with increasing International Labour Organization silicosis grading with 94.21 ± 29.4 meter, 7.11 ± 1.61% and 4.50 ± 0.93, respectively in grade “C.” A gradual change in 6-MWT parameters was also evident when compared with HRCT scan grading abnormalities. Conclusion: Results of this study shows abnormally reduced lung function parameters among subjects with silicosis and it also correlates with degree of the profusion of nodules seen radiologically both on chest radiograph and HRCT.Item Influence of COVID infection or vaccination on pregnancy outcome(National Academy of Medical Sciences, 2024-07) Satheesh, S; Tadikonda, S; Jitta, S; Hasan, AObjectives: The study aimed to assess the effect of Covid infection or Vaccination on pregnancy outcomes. Material and Methods: Infection and vaccination status of 372 women were collected during the pandemic period (March 2020 to March 2022) from medical records and personal interviews of pregnant women visiting two hospitals for antenatal care and through a survey form circulated online. Seventy-eight women were still on follow-up during the study. The women were categorized into (i) Infected during gestation, (ii) Vaccinated before pregnancy, (iii) Vaccinated during pregnancy, (iv) Vaccinated after delivery (v) unvaccinated. Individuals in (iv) and (v) categories were taken as controls. Results: Thirty-six women were infected during gestation, 156 were vaccinated before/during pregnancy, and 180 were kept as controls The result showed that 35 individuals from the sample size had adverse pregnancy outcomes such as Spontaneous abortions, MTPs (Carried out after an ultrasound detected abnormality), and Intrauterine deaths, 4 of them were infected and 23 were vaccinated before/ during pregnancy, and 8 were the controls, indicating that 77% of individuals with adverse pregnancy outcomes were exposed to either virus/vaccination. Eighty-nine women had mild complications during pregnancy, such as Oligo/Polyhydramnios, Abnormal USG, and biochemical markers. 56.1% of these individuals were exposed to the virus or vaccination, slightly higher than the control group. Conclusion: In this preliminary follow-up study, an association was seen between SARS-CoV-2 infection, COVID-19 vaccination, and adverse pregnancy outcomes.Item Serum phosphorus levels as a predictor and severity marker for mechanical ventilation in adults versus elderly patients – A cross-sectional study(National Academy of Medical Sciences, 2024-07) Ambali, AP; Tomar, P; Shivanand, LKObjectives: Mechanical ventilation (MV) is a supportive therapy for patients with acute respiratory failure. Studies have shown direct relationship between serum phosphorus on admission and risk of respiratory failure requiring MV. This study aims to determine admission serum phosphorus level’s ability to predict severity in 64 mechanically ventilated patients among two groups: Group A was designated to adults (<60 years of age) and Group B to elderly (60 years or older) admitted to the critical care unit (CCU). Study Design: It is a cross-sectional study. Material and Methods: Data were collected from 64 adults admitted to CCU. The Sequential Organ Failure Assessment (SOFA) score and serum Phosphorus level on admission were assessed. Patients with Diabetic Ketoacidosis, Head Trauma, Renal Failure, Hyper or Hypoparathyroidism, Leukaemia, and Lymphoma were excluded. Results: The study had 32 subjects in each group. The commonest indication for mechanical ventilation was Poisoning (31.25%) in Group A and Cerebrovascular Accident (34.37%) in Group B. The common complication among the study group was ventilator- associated pneumonia (14.06%). Out of 64 patients requiring mechanical ventilation, nine patients had hypophosphatemia, and eighteen had hyperphosphatemia. In the case of hypophosphatemia, 100% and in hyperphosphatemia, 55.5% mortality was observed. Conclusion: Altered serum phosphorus levels on admission can be a potential indicator for requiring MV and mortality. Both hypophosphatemia and hyperphosphatemia are potential risk factors for the development of respiratory failure. Also, age-related variation in phosphorus levels has not shown any association with the outcome.Item A rare incidence of cerebral venous thrombosis in a case of immune thrombocytopenia on eltrombopag(National Academy of Medical Sciences, 2024-07) Mishra, K; Barki, S; Sreen, A; Saravagi, G; Kumar, SImmune Thrombocytopenia (ITP) typically presents with mucocutaneous bleeding. Splenectomy, rituximab, and thrombopoietin receptor agonists (TPO-RAs) are the recommended second-line therapy. Eltrombopag is one of the TPO-RAs used for the treatment of steroid-refractory ITP, with a response rate of 70–80%. Though rare, yet various cases of venous thromboembolism have been reported from clinical trials as well as real-world studies. We present a case of ITP that was refractory to corticosteroid and second-line drugs; however, it responded to eltrombopag. While having a complete response on eltrombopag, the patient developed Cerebral Venous Thrombosis.