Introduction: In view of the present Coronavirus Disease 2019 (COVID-19) pandemic it is of utmost importance to look out for the ‘trojan horse’ that is the asymptomatic population who are potential for spreading the disease. Healthcare Workers (HCWs) are the most vulnerable group. The possibility of having the infection does not always correlate well with the symptoms. It urges the need for development of certain special plans beyond continuous surveillance and symptom monitoring. Aim: To explore asymptomatic COVID-19 infection among HCWs as a potential source of transmission. Materials and Methods: This hospital-based cross-sectional study was conducted at Medical College and Hospital, Kolkata , West Bengal, India, from June 2020 to September 2020. The data were collected from 714 HCWs over a period of three months of study period, with the help of a standard questionnaire and blood sample was analysed by serological assessment of Immunoglobulin G (IgG) for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) by EUROIMMUN Kit, EnzymeLinked Immunosorbent Assay (ELISA). Epi info software 7, available from the World Health Organization (WHO) site was used to manage and analyse the data. Results: The mean age was 35.30±11.79 years. Out of 714 people, 54.8% (391/714) were male and 45.2% (323/714) were female. In this survey, 9.16% of HCWs in COVID-19 designated duties were IgG positive; whereas 21.89% of HCWs designated in other parts of area were detected to be IgG positive. Seroprevalence was least amongst nursing staffs with 5.41% (8/148); among doctor’s it was 9.62% (41/426). Most interestingly among ward boys and cleaners this prevalence was found to be 29.90% (29/97) being the highest. Overall seroprevalence for IgG against SARS-CoV-2 was found to be 12.75% (91/714). Conclusion: This serosurvey at this tertiary COVID-19 care facility is a unique venture to look for the possible sources of super-spread. The high rate of sero-positivity among ward boys and cleaners might be due to their lack of knowledge and training regarding steps to prevent a droplet borne pandemic. This study also points out that if adequate precautions are taken, infectivity is not to an alarming extent, even in a fullfledged COVID-19 care hospital.

Context: Malaria is an inflammatory condition triggered by the infection of parasite Plasmodium on erythrocytes. It is characterised by periodic fever with chills due to rupture of erythrocytes to release the progeny parasites. It is marked by release of variety of cytokines like IL-6, IL-12, IFN-Ɣ, TNF—α etc. Uric acid is one of the emerging inflammatory markers in malaria that demands attention. One of the proposed mechanisms is that there is accumulation of uric acid and its precursor, hypoxanthine in the infected erythrocytes. These are released into the blood on rupture of the schizont.  Aim: To find association of serum uric acid level with severity of malaria.Settings and Design: This was a hospital based longitudinal study conducted at a tertiary care centre in Kolkata, India. Materials and Methods: We measured the plasma levels of uric acid and various inflammatory markers {Ferritin, C-reactive protein(CRP), LDH, C3, C4} in eighty eight  patients admitted with microscopically proven malaria (severe or non-severe type). The levels of uric acid were compared with the disease severity and the inflammatory markers stated above. Statistical Analysis used: The data was analyzed using MedCalc software and Microsoft Excel 2010 and further graphically plotted. Results: The serum uric acid levels were raised in 18.51% of patients with severe malaria compared to only 4.91% with non-severe variety (p= 0.04). The uric acid levels demonstrated a positive correlation with CRP (r=0.3334, p=0.0015); procalcitonin & ferritn (r=0.3701, p<0.0005). However, it was negatively correlated with C3 (r= -0.3780, p= 0.0003) and C4 (r=0.3180, p<0.005). A univariate regression analysis supported our results to establish the correlation. However, multiple logistic regression analysis demonstrated significant association between serum uric acid levels on day 1 and C3 decrement as a marker of disease severity.  Conclusion:  Thus, it can be concluded that there is a definite association between the severity of malaria and plasma uric acid levels. Although, this study does not establish the causation, it acts as a cornerstone for further research into this field.

Background Hashimoto’s encephalopathy, also known as steroid responsive encephalopathy associated with autoimmune thyroiditis (SREAT) is an autoimmune neuroendocrine disorder marked by impaired brain function. It is a diagnosis of exclusion with variable nature of presentation and no gold standard investigation of choice. Case presentation Here, we report a case of SREAT in a 26-year-old female who presented to our Emergency Department with altered sensorium and generalised tonic clonic seizures. After thorough clinical examination and initial resuscitation, a provisional diagnosis of neuroglycopenic injury or possible encephalitis was made. Broad-spectrum antibiotics were initiated. Routine investigations and cerebrospinal fluid (CSF) study were inconclusive except for neutrophilic leucocytosis. Magnetic resonance imaging (MRI) depicted hyper-intense signal changes around bilateral hippocampus and thalamus. Serum anti-thyroid peroxidase (anti-TPO) was strongly positive while other serum and CSF autoantibodies were within normal limits. A diagnosis of SREAT was made and she responded brilliantly to systemic corticosteroids. Incidentally, anti-SSA (anti-Ro) and anti-SSB (anti-La) were positive and a possible association between Sjogren’s syndrome and SREAT was insinuated. Conclusion There is a long list of differentials for SREAT and a proper diagnostic criteria must be followed to reach at a conclusion. It can be easily missed and remain underreported due to its overlapping nature and ambiguous presentation. Hence, clinicians must have high index of suspicion for the disease and optimal therapy should be initiated early to improve the long term mortality.

Introduction: Systemic Lupus Erythematosus (SLE) patients have an increased burden of atherosclerosis leading to adverse Cardiovascular (CV) events. Alterations in endothelial function, dysregulated immune system and increased oxidative stress are implicated in their development and progression. Carotid artery ultrasound is recommended to assess and follow progression of subclinical atherosclerosis and correlate with traditional/non traditional CV risk factors in SLE. Aim: To study the correlation between Carotid Intima Media Thickness (CIMT), traditional/non traditional CV risk factors in SLE. Materials and Methods: The hospital-based, descriptive, cross-sectional study was conducted in the Department of Internal Medicine, Medical College Kolkata, Kolkata, West Bengal, India, from April 2019 to August 2020. Patients with SLE, diagnosed by Systemic Lupus International Collaborating Clinics (SLICC) 2012 criteria, aged >12 years, irrespective of therapy status, were recruited by consecutive sampling. Subjects were classified as Lupus Nephritis (LN) and Lupus without Nephritis (LWN). Demographic data, parameters to define SLE (SLICC 2012 criteria), blood parameters like lipid profile, fasting plasma glucose, anti-Double stranded Deoxyribose Nucleic Acid antibody (anti-dsDNA Ab), C3/C4 levels, 24 hour urine protein values, haemoglobin, C-reactive Protein (CRP), serum homocysteine and Carotid Intima Media thickness as measured by Ultrasonography (USG) doppler study, duration of disease and medication history were considered as study variables. Statistical analysis was done by using Z-test, t-test, Analysis of variance (ANOVA), Chi-square test (for categorical data) and other non parametric statistical tests and correlation tests wherever applicable. A p-value <0.05 was considered to be statistically significant. Results: Fifty five SLE patients were studied. Subgroup analysis was performed between LN (n=36) and LWN (n=19). The mean age of the study subjects was 33 years with mean disease duration of 4.6 years. LN patients had longer disease duration, younger age of disease onset and longer duration of steroid usage. The mean systolic Blood Pressure (BP) was significantly higher in LN subgroup. Framingham Risk Scores (FRS) was positively correlated with duration of SLE disease and Systemic Lupus Erythematosus Disease Activity Index (SLEDAI-2K) scores and duration of steroid therapy. The mean CIMT of the study population is 0.91 mm with 10.9% plaque prevalence whereas, mean CIMT of the LN subgroup and LWN subgroup was 1.02±0.27 mm and 0.86±0.3 mm, respectively; however no statistically significant difference in CIMT was observed between two subgroups. CIMT positively correlated with anti-dsDNA Ab levels, FRSs, anaemia, SLE Disease activity scores, 24 hour urine protein, duration of steroid usage, serum creatinine and CRP. No correlation between CIMT and age of subjects, Fasting Plasma Glucose (FPG), Triglycerides (TG) serum homocysteine was observed. Conclusion: Systemic lupus erythematous patients have a high atherosclerosis burden and are at increased risk of adverse CV events. LN patients, early age of lupus onset, longer disease duration with prolonged steroid therapy, significant proteinuria, higher anti-dsDNA Ab levels and hypocomplementemia were observed to have higher mean CIMT and plaque formation.

Interstitial lung disease (ILD) is a collective term for a group of disorders that result in inflammation and scarring of the lung interstitium. Although majority of the cases of ILD are idiopathic, some of the etiologies can range from viral infections; connective tissue disorders or drug injury. Docetaxel is an anticancer agent of taxoid family that can rarely cause pulmonary toxicity.  It can be occasionally used for the management of advanced prostate cancer. The adverse effects of the medication are mediated by type I and type IV hypersensitivity reactions.  Here, we reported a case of 68-year-old man with advanced prostate cancer who completed six cycles of chemotherapy with docetaxel and presented with shortness of breath, low-grade fever and cough two weeks after completion of scheduled regimen. Clinical examination revealed diffuse wheeze and decreased air entryon auscultation, oxygen desaturation and an ulcerative lesion on the left forearm. All his routine serum, sputum and autoimmune profile were inconclusive. The inflammatory markers (CRP, ESR) were raised but procalcitonin was in normal range. Pulmonary function tests were indicative of restrictive lung disease. Digital chest X-ray revealed diffuse opacification with prominent bronchovascular markings and HRCT of thorax reported bilateral scattered honeycomb appearance, subpleural opacities, centrilobular nodules with air trapping. Docetaxel induced interstitial lung disease (DILD) was diagnosed and the patient was advised with high dose systemic and inhalational steroids along with external oxygen support.  Rapid clinical improvement was seen and the patient was eventually discharged with tapering doses of oral steroids, physiotherapy and close follow-up.