Cotrimoxazole-induced SIADH — a unique challenge during treatment of pulmonary nocardiosis

A 62 year old male non-smoker diagnosed with pulmonary nocardiosis was initiated on Cotrimoxazole therapy at a dose of 20 mg/kg per day in three divided doses. He developed hyponatremia (serum sodium 105 mEq/L) on day 3 of therapy. The potential causes of hyponatremia were evaluated. After ruling out other causes, the cause was suspected to be Cotrimoxazole-induced syndrome of inappropriate anti-diuretic hormone secretion (SIADH). We subsequently re-initiated therapy with Cotrimoxazole and the hyponatremia (serum sodium 110 mEq/L) recurred. Upon discontinuation of therapy, serum sodium levels returned to normal. The patient was started on Amoxycillin-Clavulanic Acid as an alternative therapy for pulmonary nocardiosis which resulted in resolution of the hyponatremia. Cotrimoxazole-induced SIADH is a rare occurrence. This case is representative of a patient with Cotrimoxazole-induced SIADH and the causal relationship was confirmed once resumption of therapy with the offending medi-cation resulted in hyponatremia. Clinicians should be aware of this rare adverse effect of Cotrimoxazole and should monitor serum electrolytes during therapy, especially in the elderly and in those receiving high doses

Clinical outcome, viral response and safety profile of chloroquine in COVID-19 patients — initial experience

Introduction: Chloroquine and its analogues are currently being investigated for the treatment and post exposure prophylaxis of COVID-19 due to its antiviral activity and immunomodulatory activity.Material and methods: Confirmed symptomatic cases of COVID-19 were included in the study. Patients were supposed to receive chloroquine (CQ) 500 mg twice daily for 7 days. Due to a change in institutional protocol, initial patients received chloroquine and subsequent patients who did not receive chloroquine served as negative controls. Clinical effectiveness was determined in terms of timing of symptom resolution and conversion rate of reverse transcriptase polymerase chain reaction (RT-PCR) on day 14 and day 15 of admission.Results: Twelve COVID-19 patients formed the treatment arm and 17 patients were included in the control arm. The duration of symptoms among the CQ treated group (6.3 ± 2.7 days) was significantly (p-value = 0.009) lower than that of the control group (8.9 ± 2.2 days). There was no significant difference in the rate of RT-PCR negativity in both groups. 2 patients out of 12 developed diarrhea in the CQ therapy arm.  Conclusion: The duration of symptoms among the treated group (with chloroquine) was significantly lower than that of the control group. RT-PCR conversion was not significantly different between the 2 groups

Cotrimoxazole-Induced SIADH—A Unique Challenge during Treatment of Pulmonary Nocardiosis

A 62 year old male non-smoker diagnosed with pulmonary nocardiosis was initiated on Cotrimoxazole therapy at a dose of 20 mg/kg per day in three divided doses. He developed hyponatremia (serum sodium 105 mEq/L) on day 3 of therapy. The potential causes of hyponatremia were evaluated. After ruling out other causes, the cause was suspected to be Cotrimoxazole-induced syndrome of inappropriate anti-diuretic hormone secretion (SIADH). We subsequently re-initiated therapy with Cotrimoxazole and the hyponatremia (serum sodium 110 mEq/L) recurred. Upon discontinuation of therapy, serum sodium levels returned to normal. The patient was started on Amoxycillin-Clavulanic Acid as an alternative therapy for pulmonary nocardiosis which resulted in resolution of the hyponatremia. Cotrimoxazole-induced SIADH is a rare occurrence. This case is representative of a patient with Cotrimoxazole-induced SIADH and the causal relationship was confirmed once resumption of therapy with the offending medi-cation resulted in hyponatremia. Clinicians should be aware of this rare adverse effect of Cotrimoxazole and should monitor serum electrolytes during therapy, especially in the elderly and in those receiving high doses

Emotional distress among health professionals involved in care of inpatients with COVID-19: a survey based cross-sectional study

Introduction: Health care workers (HCWs) are directly involved in processes linked with diagnosis, management, and assistance of coronavirus disease-19 (COVID-19) patients which could have direct implications on their physical and emotional health. Emotional aspects of working in an infectious pandemic situation is often neglected in favour of the more obvious physical ramifications. This single point assessment study aimed to explore the factors related to stress, anxiety and depression among HCWs consequent to working in a pandemic. Material and methods: This was a cross-sectional study involving healthcare workers who were working in COVID-19 inpatient ward, COVID-19 screening area, suspect ward, suspect intensive care unit (ICU) and COVID-19 ICU across four hospitals in India. A web-based survey questionnaire was designed to elicit responses to daily challenges faced by HCWs. The questionnaire was regressed using machine-learning algorithm (Cat Boost) against the standardized Depression, Anxiety and Stress Scale — 21 (DASS 21) which was used to quantify emotional distress experienced by them. Results: A total of 156 participants were included in this study. As per DASS-21 scoring, severe stress was seen in ∼17% of respondents. We could achieve an R2 of 0.28 using our machine-learning model. The major factors responsible for stress were decreased time available for personal needs, increasing age, being posted out of core area of expertise, setting of COVID-19 care, increasing duty hours, increasing duty days, marital status and being a resident physician. Conclusions: Factors elicited in this study that are associated with stress in HCWs need to be addressed to provide wholesome emotional support to HCWs battling the pandemic. Targeted interventions may result in increased emotional resilience of the health-care system

Clinical Outcome, Viral Response and Safety Profile of Chloroquine in COVID-19 Patients—Initial Experience

Introduction: Chloroquine and its analogues are currently being investigated for the treatment and post exposure prophylaxis of COVID-19 due to its antiviral activity and immunomodulatory activity. Material and methods: Confirmed symptomatic cases of COVID-19 were included in the study. Patients were supposed to receive chloroquine (CQ) 500 mg twice daily for 7 days. Due to a change in institutional protocol, initial patients received chloroquine and subsequent patients who did not receive chloroquine served as negative controls. Clinical effectiveness was determined in terms of timing of symptom resolution and conversion rate of reverse transcriptase polymerase chain reaction (RT-PCR) on day 14 and day 15 of admission. Results: Twelve COVID-19 patients formed the treatment arm and 17 patients were included in the control arm. The duration of symptoms among the CQ treated group (6.3 ± 2.7 days) was significantly (p-value = 0.009) lower than that of the control group (8.9 ± 2.2 days). There was no significant difference in the rate of RT-PCR negativity in both groups. 2 patients out of 12 developed diarrhea in the CQ therapy arm. Conclusion: The duration of symptoms among the treated group (with chloroquine) was significantly lower than that of the control group. RT-PCR conversion was not significantly different between the 2 groups