Prevalence and risk factors of sarcopenia: a study in a tertiary care centre Lalatendu Mohanty*, Debananda Sahoo INTRODUCTIONAging is known to be a natural process but is associated with significant decline in neuromuscular function and performance. 1,2 Sarcopenia is a syndrome which is characterized by progressive and generalized loss of skeletal muscle mass and strength. It has a high risk of adverse outcomes such as decreased function of lower limbs, physical disability and poor quality of life. [3][4][5][6] The known causes for sarcopenia are usually age related, changes in tissue secretions or response to hormonal factors, changes in dietary intake, protein metabolism and disuse atrophy. 7-9The age and sex adjusted sarcopenia is estimated to vary from 6% to 24%, depending on the definition and measure of muscle mass. [10][11][12] In a cohort study in New Mexico, the prevalence was greater than 50% in people over 80 years of age. 11ABSTRACT Background: Sarcopenia is characterized by progressive and generalized loss of skeletal muscle mass and strength. The known causes for sarcopenia are usually age related, changes in tissue secretions or response to hormonal factors, changes in dietary intake, protein metabolism and disuse atrophy. This study was conducted to identify the predictors for sarcopenia among the elderly patients in our area. Methods: 678 patients above the age of 60 years and 50 young patients between the age of 18-40 years (to establish a baseline value) were recruited into the study. Height and weight were measured for all the patients, and BMI was calculated. Lean body mass, appendicular skeletal muscle mass (ASM), and total skeletal mass (TSM) was measured from the controls as well as the patients. Results: Out of the 678 patients, 346 were males and 332 were females. The prevalence of sarcopenia was found to be 15.3% among the elderly males and 20.5% among the females. The lean body mass and the appendicular skeletal mass were significantly more in males than females. Of the risk factors which we studied, there was no significance between the sarcopenic and non sarcopenic individuals. There was a significant difference in the other metabolic factors such as lower protein levels and lower steroid hormones although the numbers were very small in our study. Conclusions: This confirms that the relative muscle mass in significantly lower among the elderly population as compared to the younger generation. Sarcopenia is found to increase the likely hood of disability in these patients independent of the age, weight, BMI, other factors of morbidity and health factors. Therefore, criteria for estimating prevalences of sarcopenia are needed for public health planning purposes.

Burkholderia is a gram-negative bacillus causing infections in immunocompromised patients. It is commonly seen in the tropics and is known to mimic tuberculosis clinically. Six patients were reviewed who were admitted in our hospital between July 2018 to June 2019 after obtaining their consent. All the six patients were uncontrolled diabetics with HbA1c levels between 8.2-13.9% who presented with fever more than 2 weeks and had abdominal symptoms like vomiting, abdominal pain or loss of appetite. Some also had respiratory symptoms like cough, chest pain and breathlessness. All of them had leucocytosis (neutrophilic). Mild transaminitis was also observed. CT abdomen revealed presence of multiple hepatic and splenic abscesses in all the patients. Chest X-ray revealed bilateral pneumonia in five patients. Burkholderia cepacia was found in the blood of four patients, sputum of one patient and splenic pus aspirate of one patient. Four patients were treated with meropenem and rest with ceftazidime. All of them responded well to treatment and became asymptomatic. Ultrasonography abdomen at follow-up was negative for any intra-abdominal abscesses. They were also put on long term oral co-trimoxazole. The clinical presentation of Burkholderia closely mimics tuberculosis as it predominantly affects immunocompromised and causes a long-duration multi-systemic illness. There has been several case series of intra-abdominal abscesses caused by Burkholderia pseudomallei but infections by Burkholderia cepacia in the abdomen is a rare finding. The diagnosis of burkholderia is often delayed due to its inconspicuous nature, lack of clinical suspicion and often mimicking tuberculosis clinically.

No abstract

Introduction: Scrub typhus is a re-emerging illness in the South-East Asia and other parts of the world caused by Orientia tsutsugamushi, which is a mite-borne bacterium belonging to the Rickettsiaceae family. It has varied clinical manifestations and affects multiple organ systems. In Asia, about 1 million new cases are identified annually. Aim: The aim was to conduct a retrospective study to observe the clinical profile and complications of scrub typhus in South-Eastern India. Materials and Methods: Clinical data of 240 patients who were 18 years of age or above, admitted in the Department of Internal Medicine and diagnosed with scrub typhus by means of IgM Enzyme-linked Immune Sorbent Assay (ELISA) was collected. Demographic profile, clinical signs and symptoms, laboratory parameters, co-infections and complications were reviewed. Statistical analyses were performed using Chi-square test. Results: Majority of the patients were males, between the age of 18-29 years and lived in rural areas. Forty-three (17.9%) patients were admitted in the ICU and the remaining in wards. Sixty-nine (28.8%) patients had consolidation and 11 (4.6%) had Acute Respiratory Distress Syndrome (ARDS). Twenty-one (8.8%) patients had jaundice and 76 (31.7) had hepatomegaly. Twenty-one (8.8%) patients had meningo-encephalitis and 18 (7.5%) had acute kidney injury. Twelve (5%) patients had co-infection with dengue and 8 (3.3%) had malaria. Conclusion: This study shows wide and varied presentation of scrub typhus infection along with the course of the disease and response to the treatment. The diagnostic clues such as fever, eschar, rashes, lymphadenopathy should be kept in mind by a primary care physician as early recognition and treatment can prevent its dangerous complications and reduce the mortality due to the disease. Occurrence of co-infections should also be kept in mind for better management of the patient.

No abstract