International Medical Journal

SARS-CoV2 (Severe Acute Respiratory Syndrome Coronavirus 2) has been the cause for the pandemic, Coronavirus Disease-2019 (COVID-19). The immune responses exhibited by the individuals to COVID-19 are highly heterogeneous. What is intriguing is the fact that in majority of individuals the immune response seems ineffective and, in few individuals, especially with severe disease there seems to be exaggerated or abnormal immune response. This article has been decided to focus on the understanding the immunopathogenesis caused by SARS-CoV2 infection. The study included 50 articles published in the last 20 years searched in PubMed, EMBASE, Cochrane library, PubMed Central, UpToDate and Medline. The collected articles include original articles, review articles as well as case reports and case series. Since this article was a review article, it did not require ethics approval. Ethics approval was not obtained as it was a review article. SARS-CoV2 virus presents with clinical manifestations ranging from respiratory system to central nervous system manifestations. Presentation is highly heterogeneous varying irrespective of age, sex, presence or absence of comorbid conditions. Inflammatory mechanisms are found to play a role in the severity of the disease. The proinflammatory cytokines and chemokines are activated with increased number in SARS-C0V2 infections. When the extent of viral infection or magnitude of antigen to be handled by the inflammatory response is adequate resulting in recovery. When the viral load is high the anti-inflammatory response is not sufficient to match that of the proinflammatory effects resulting in mortality or prolonged morbidity.

Managing perioperative pain is a challenge for the treating surgeon and anesthesiologist. Transdermal route of drug administration is a novel method to deliver drugs in a simple, non-invasive and compliant way. In this prospective, randomized, double blinded, comparative study, we intent to compare the preemptive use of transdermal Buprenorphine patches of 5 mg and 10 mg, for analgesia, post operatively in lower limb orthopedic surgeries under spinal anesthesia. The results obtained showed that the Numerical Rating scale (NRS) scores were on higher side at all periods of observation in the 5 mg group and this difference was statistically significant. The NRS scores during rest and on movement in the pre- operative period and the period just before surgery were slightly higher in 5 mg group but this difference was not statistically significant. But the 8 hours ,12 hours, 24 hours, 48-hour post-surgery NRS scores were higher in the 5 mg group and this difference was statistically significant (p<0.05) during rest and on movement. The rescue analgesia required by the 5 mg group was also higher than the 10 mg group and was statistically significant. Hence the 10 mg patch was more effective than the 5 mg patch for postoperative analgesia.

Hepatitis B virus (HBV) infection is a serious health problem affecting nearly 400 million people worldwide, which can lead to liver fibrosis. Mean Platelet Volume (MPV) and Platelet Distribution Width (PDW) are part of a complete blood count. High MPV and PDW values have been observed in hepatitis B patients with severe liver fibrosis. This study aimed to determine the correlation between degree of liver fibrosis with MPV and PDW in chronic hepatitis B patients. MPV and PDW data were collected from medical records of naive hepatitis B patients who underwent transient elastography (FibroScan) examination at Wahidin Sudirohusodo Hospital Makassar from January 2018 - December 2020. Degree of liver fibrosis determined by FibroScan. The statistical tests used were Pearson's correlation and ANOVA. The results were considered significant if p-value <0.05. This study included 862 subjects consisting of 62.8% male with a mean age of 39.1 ± 13.1 years. The distribution of FibroScan results were 63.1% non-fibrosis, 20.4% significant fibrosis, and 15.5 severe fibrosis. The degree of liver fibrosis has a significant positive relationship with each MPV and PDW, the higher degree of liver fibrosis is in accordance with higher MPV and PDW (each p<0.001). The highest mean of MPV and PDW were found in severe fibrosis (9.2 fl and 13.5 fl). The degree of liver fibrosis has a significant positive relationship with each MPV and PDW in chronic hepatitis B patients.

Amyloidosis is a group of heterogeneous diseases characterized by extracellular deposition of proteinaceous material in various organs.  Multiple dermatological manifestations of amyloidosis have been described, including nodules, papules, plaques and periorbital ecchymosis. We report a case of idiopathic primary systemic amyloidosis presenting with unusual extensive upper and lower limbs ecchymoses along with laryngeocel, lacking the classical presentation of macroglossia, waxy papules, and plaques.

Obesity has been linked with increased morbidity and mortality although the causes of obesity are not well understood. Its’ obvious involvement in the respiratory system causing obesity hypoventilation syndrome (OHS), obstructive sleep apnoea(OSA) and abnormal pulmonary function is well known, but how the presence of excess fat in the body is involved in the various inflammatory or other disease of the respiratory system are not clearly known. In this presentation, we further explore the mechanism involved in alterations in lung function caused by obesity. It is observed that obese individuals have increased respiratory rates, reduced tidal volumes and decreased total lung compliance. The lung volumes are usually reduced, especially expiratory reserve volume. However, in most cases, airway resistance and gas exchange seem to be relatively well preserved. Obese individuals usually have mild hypoxemia due to ventilation- perfusion imbalance in bases of lung fields possibly due to micro atelectasis. Weight loss in such individuals to a large extent may reverse these changes.