COVID-19 has caused devastating effects worldwide ever since its origin in December 2019. IL-6 is one of the chief markers used in the management of COVID-19. We conducted a longitudinal study to investigate the role of IL-6 in diagnosis, treatment, and prognosis of COVID-19-related cytokine storm. Patients with COVID-19 who were admitted at AIIMS Rishikesh from March to December 2020 were included in the study. Patients with no baseline IL-6 value at admission and for whom clinical data were not available were excluded. Clinical and laboratory data of these patients were collected from the e-hospital portal and entered in an excel sheet. Correlation was seen with other inflammatory markers and outcomes were assessed using MS Excel 2010 and SPSS software. A total of 131 patients were included in the study. Of these, 74.8% were males, with mean age 55.03 ± 13.57 years, and mean duration from symptom onset being 6.69 ± 6.3 days. A total of 82.4% had WHO severe category COVID-19, with 46.56% having severe hypoxia at presentation and 61.8% of them having some comorbidity. Spearman rank correlation coefficient of IL-6 with D-dimer was 0.203, with LDH was −0.005, with ferritin was 0.3, and with uric acid was 0.123. A total of 11 patients received Tocilizumab at a mean duration from symptom onset of 18.09 days, and 100% mortality was observed. Deaths were reported more in the group with IL-6 ≥ 40 pg/mL (57.1% vs. 40.2%, p = 0.06). ICU admissions and ventilator requirement were higher in the IL-6 ≥ 40 pg/mL group (95.9% vs. 91.4%, p = 0.32 and 55.1% vs. 37.8%, p = 0.05). The study showed that IL-6 can be used as a possible “thrombotic cytokine marker”. Higher values of IL-6 (≥40 pg/mL) are associated with more deaths, ICU admissions, and ventilator requirement.

Enoxaparin-mediated bullous hemorrhagic dermatosis (BHD) is one of the rare side effects during prophylaxis of enoxaparin for various thromboembolic events. We report a case of a 74-year-old female with multiple comorbidities who developed BHD at a distant site from subcutaneous delivery of enoxaparin. Histopathological analysis confirmed the diagnosis of BHD. Discontinuation of enoxaparin resulted in the gradual resolution of the bullae formation, and the patient was started on novel oral anticoagulation with apixaban. The usual cutaneous adverse effects of enoxaparin include maculopapular rash, pruritus, skin necrosis, eczematous dermatitis, and rarely bullous hemorrhagic dermatosis. This hemorrhagic bullae dermatosis at a distant site from the administration is a relatively rare and benign side effect of enoxaparin which is an under-recognized complication of low-molecular-weight heparin.

Partial or complete obstruction of blood flow in venous sinuses of the brain leads to a clinical condition termed cerebral venous sinus thrombosis (CVST). In most diagnosed cases, CVST has at least one risk factor identified among many postulated, and it most commonly includes acquired or inherited prothrombotic conditions. Steroid intake for intentional weight gain is prevalent in the general population, especially among new-generation bodybuilders and athletes. Excess exogenous steroids have many adverse effects, and increasing the risk of venous thromboembolism is one of them. The role of these steroids in developing CVST among such individuals has not been reported frequently in the literature. We report a case of a young male with a history of chronic exogenous steroid intake to increase his body weight, who presented with clinical features of CVST.

Chronic, uncontrolled hyperglycemia is associated with an increased incidence of coronary artery disease, cardiac failure, diabetic nephropathy, diabetic retinopathy, and associated mortality. A 72-year-old female presented to the OPD with multiple episodes of loss of consciousness for the past 1 month. The patient also had other comorbidities such as hypertension, diabetes mellitus (DM), and hypothyroidism. On systemic examination, her blood pressure was 124/77 mmHg (supine) and 116/72 mmHg (standing), and her pulse rate was 56 beats/min. She had a loss of vibration sense in both lower limbs up to the ankle. Fundus examination showed non-proliferative diabetic retinopathy. The rest of the systemic examination was clinically normal. Her HbA1C was 8.1%, and other routine investigations were within normal limits. Electrocardiography (ECG) showed sinus bradycardia. Echocardiography showed normal ventricular function with no evidence of ischemic heart disease (IHD). 24-h Holter ECG revealed sinus bradycardia with an intraventricular conduction defect, a third-degree AV block with junctional beats, and rare supraventricular ectopics. This is a case of Type 2 DM with complete heart block (CHB) of spontaneous onset. Other causes of AV block have been ruled out, and it seems that this case of CHB is possibly due to cardiac autonomic neuropathy (CAN). Multiple factors, such as the duration of diabetes, poor glycemic control, metabolic derangements, and genetic factors, determine CAN. This case emphasizes that patients with type 2 diabetes without IHD can develop CHB spontaneously.

Introduction: Antithyroid drugs (ATDs) are first-line therapy for Graves’ disease but are contraindicated in acute hepatocellular injury. When ATDs must be withheld and radioactive iodine (RAI) cannot be performed immediately due to iodine loading or unstable hepatic status, managing persistent thyrotoxicosis becomes challenging. We report a case of Graves’ disease complicated by incidental acute Hepatitis B, managed with a non-thionamide bridging regimen to successful RAI ablation. Methods/Case Report: A 35-year-old female with Graves’ disease on Carbimazole 10mg OD presented with jaundice, dark urine, and burning micturition, with icterus on examination. Evaluation revealed markedly deranged LFTs and coagulopathy, confirmed as acute Hepatitis B on viral markers and DNA load. Carbimazole was withheld. Thyrotoxicosis was controlled using Lugol’s iodine, Lithium, and Cholestyramine, without ATD re-exposure. Tenofovir DF, N-acetylcysteine, and UDCA were initiated for Hepatitis B. Serial monitoring of liver function (SGOT/SGPT, bilirubin, INR) and thyroid function (fT3, fT4, TSH) guided sequential therapeutic decisions, in coordination with Hepatology and Nuclear Medicine. After iodine washout, a Tc-99 thyroid uptake scan was performed to assess candidacy for RAI. Results: Peak transaminases reached SGOT 2007 U/L, SGPT 1693 U/L, with total bilirubin 14.75 mg/dl and INR 1.89. Following Tenofovir initiation, liver enzymes and bilirubin showed progressive improvement. Thyroid function normalized on the bridging regimen (TSH remaining suppressed but fT3/fT4 trending down). Tc-99 uptake scan showed 11% bilateral uptake, permitting RAI ablation (15 mCi I-131) on hospital day 24, with no post-procedural thyroid storm. Conclusion: Lithium, Cholestyramine, and Lugol’s iodine offer an effective ATD-sparing bridge to control thyrotoxicosis in patients with severe concurrent hepatic dysfunction, enabling safe transition to RAI ablation once hepatic and biochemical parameters permit — avoiding re-exposure to potentially hepatotoxic thionamides while achieving definitive thyroid control.

Background: The COVID-19 pandemic has resulted in a significant increase in mental health issues, including depression, anxiety, post-traumatic stress disorder and sleep disturbances, particularly among recently hospitalised patients. Non-pharmacological interventions such as Yoga Nidra and Music Therapy offer cost-effective and accessible alternatives for improving psychological well-being and sleep quality in this population. Purpose: This study aimed to investigate the effects of Yoga Nidra and Music Therapy on sleep quality, mental health and overall well-being among recently recovered, hospitalised COVID-19 patients. Methods: This three-arm, parallel-group, randomised controlled trial (RCT) enrolled 90 adults recently discharged following COVID-19 hospitalisation. Participants were randomised in a 1:1:1 ratio into Yoga Nidra, Music Therapy or standard care groups. Both interventions were delivered online via Zoom for 30 min daily over 30 days. Sleep quality, mental health and well-being were assessed using the Pittsburgh Sleep Quality Index (PSQI), the Patient-Reported Outcomes Measurement Information System (PROMIS ^® ) Global Health Scale and the World Health Organization Well-Being Index (WHO-5) at baseline day 0, day 15 and day 30. All outcomes were treated as exploratory. Results: Both the Yoga Nidra and Music Therapy groups demonstrated significant improvements in PSQI, PROMIS and WHO-5 scores at day 15 and day 30 compared with the control group ( p < .001 for all measures). Large effect sizes were observed across outcomes (partial η ² = 0.195–0.795). Yoga Nidra showed greater improvements in overall well-being (WHO-5) and global health (PROMIS ^® ), while Music Therapy demonstrated stronger effects on sleep quality (PSQI). No significant changes were observed in the control group. No adverse events were reported. Conclusion: In this exploratory RCT, Yoga Nidra and Music Therapy were associated with significant improvements in sleep quality, mental health and overall well-being among post-COVID-19 hospitalised patients compared with standard care alone. These accessible, low-cost therapies may serve as valuable adjuncts to standard care for managing post-COVID psychological distress and sleep disturbances. Larger confirmatory trials are warranted.