A retrospective study on the clinical picture of COVID-19 patients associated with type 2 diabetes mellitus in India

Background: The clinical characterization of COVID varies from mild to severe. In the initial phases of the disease, symptoms like fever, cough, and dyspnea can occur. The severity and outcome of COVID vary with preexisting conditions, particularly type 2 diabetes mellitus (T2DM). Objective of current study was to assess the clinical presentation and laboratory derangements of COVID-19 patients associated with T2DM.Methods: The present retrospective study was started after the approval of the Institutional Ethics Committee. Various clinical (Sp02, final diagnosis, co-morbidity, and outcome) and biochemical parameters (CBC, LFT, RFT, LDH, Trop I, CK-MB D-dimer, CRP, ferritin levels, RBS, HbA1c) of Covid-19 patients were collected from Central Laboratory and & Medical Record Department of our institution. Patient names were anonymized and data were analyzed. The results are expressed in percentages.Results: A total of 24 COVID-19 patients (with T2DM) details were collected from the medical record department and central laboratory. Out of 24 patients, 16 (66.6%) were male, and the remaining 08 (33.3%) were female. Out of 24, 05 patients had mild covid, 02 were moderate and the remaining 17 suffered from severe COVID. The mean values of oxygen saturation, LDH, D-dimer, Troponin-I, CRP, Ferritin, Procalcitonin, and CK-MB were 76%, 797.3 U/l, 1614.2 ng/ml, 6.93 ng/ml, 72.6 mg/dl, 521.2 µg/l, 2.33 µg/l and 40.59 ng/ml respectively. The average random blood sugar level and glycosylated hemoglobin were 308.8 mg/dl and HbA1c 10.22%. Mean values of 42.5 mg/dl and 1.54 mg/dl were recorded for blood urea and S. creatinine. Regarding liver function test, mean values of 0.87 mg/dl, 0.37 mg/dl, 0.49mg/dl, 344.8U/l, 115.6U/l,108U/l respectively noted for total bilirubin, direct, indirect, SGOT, SGPT and ALP. Regarding patient outcome, 09 (37.5%) patients recovered and 15 (62.5%) died due to COVID. The values of glycosylated Hb and random blood sugar among the 15 patients who died due to covid infection suggested uncontrolled diabetes Mellitus in 7 of them with associated hypertension and died due to septic shock. Conclusions: Though the laboratory mean values of the liver function test and renal function test shows moderate variations the mean values of CRP, LDH, Procalcitonin, and Ferritin which are the acute inflammatory markers are highly disrupted when compared to normal ranges. 

Analysis of results of huge segmental bone loss of tibia treated with Ilizarov external fixator: our experience in Indian population

Background: Orthopaedic surgeons face challenges in treating complex tibial fractures with bone loss due to complications like infection, repeat surgeries, and patient psychological burden. The Ilizarov external fixator approach offers better clinical and radiological results, addressing these issues. The purpose of this study was to examine the outcome of tibial segmental loss treated with the Iliazrov external fixator. Methods: The study was done between January 2015 to December 2021. It’s a prospective as well as retro-prospective study. The age group of 18-65 years was considered. Patients were monitored monthly, up to nine months post-surgery, or until bone union. Functional and bone outcomes of the patients were evaluated using ASAMI criteria, knee society score, and St. Pierre ankle scoring system. Results: The study included 20 patients, all of them were male and had a mean age of 34.1±10.1. Bone union was achieved in all cases. After ilizarov application, the average bone defect was 82.6±42.9 mm. The final regeneration attained was 75.1±47.5 mm. The average limb length difference was 20.41±6.55 mm after achieving union. Out of 20 patients, 13 and 4 had good and fair ASAMI score, 1, 4, and 13 had fair, good, and excellent knee society score, and17 had fair St. Pierre score and 3 patients were lost to follow-up. Conclusions: Ilizarov technique is an excellent way for treating complicated tibial fractures. The difficulties, challenges, and complications associated with Ilizarov external fixation are negligible compared to the significant difficulties associated with open techniques

ASSESSMENT OF LEFT ATRIAL FUNCTION IN PATIENTS WITHMITRAL VALVE DISEASES

ABSTRACTObjective:To observe and assess left atrial (LA) function by observing the differences in conventional Doppler echo parameters of left ventricular inflow, Left atrial appendage, among patients with mitral valve disease.Methods: Forty three mitral valve disease subjects appearing consecutively for echocardiogram (ECHO) test at the cardiology department in a tertiary care hospital were recruited into the study as per the pre-set inclusion and exclusion criteria. The data from the ECHO was pooled using Microsoft excel and analyzed using SPSS software by application of appropriate statistical tests.Results:Of the 43 objects, 39 had MS, 3 had MR and 2 of them were found to have both MS and MR. The major presenting symptom as observed in 33 subjects, was dyspnea. LA maximum volume was found to be 91±59 ml and minimum was 66±51 ml. Left atrial expansion index was 128±91. Left atrial active emptying fraction was 29±13 and passive emptying fraction was 31±15. No significant change in LA global strain among groups with MR and without MR was observed. Further, no significant difference was observed in left atrial indices like left atrial emptying fraction, left atrial passive emptying fraction, atrial fraction, Left atrial expansion index among   groups having MR and no MR.Conclusion:LA contractile, reservoir and conduit function was significantly reduced in mitral valve diseases due to increased hemodynamic load. No significant difference was noted in global LA strain irrespective of MS or MR.Key Words: Valvular disease; Left atria; Strain; Contractile functio

Effectiveness of multi-component modular intervention among adults with prehypertension in a village of Dakshina Kannada district - a community-based interventional study – protocol [version 2; peer review: 2 approved]

Introduction: The Joint National Committee (JNC 7) report on Prevention, Detection, Evaluation, and Treatment of Hypertension, defined "prehypertension," as individuals with a Systolic Blood Pressure (SBP) in the range of 120–139 mmHg and a (diastolic blood pressure) DBP of 80–89 mmHg. Prehypertension is directly linked with hypertension which is a precursor of CVDs. Owing to its high conversion rate to hypertension, it is important to identify individuals with blood pressures in this category and bring about lifestyle modifications in them that can prevent them from being hypertensive and from developing cardiovascular diseases later in life. Methods: This randomized controlled trial will be done among the selected pre-hypertensive adults of all genders residing in Kateel Gram panchayat, Dakshina Kannada district, Karnataka. A baseline survey will be done initially to assess the level of prehypertension among the study population. To study the effectiveness of the intervention, 142 individuals will be randomly allocated using block randomization technique to intervention and control groups. A multi-component module (educational intervention) will be developed, validated, and administered to participants in the intervention group, while the control group receives standard care. Each participant will then be followed up once in four months till the end of the study period of one year to assess for changes in SBP, DBP, WHR, BMI, stress levels, and usage of tobacco and alcohol. Ethics and dissemination: Institutional Ethics Committee approval was obtained from Kasturba Medical College in Mangalore, India.   The plans for dissemination of findings include presenting at scientific conferences and publishing in scholarly journals

Dietary phytochemicals, HDAC inhibition, and DNA damage/repair defects in cancer cells

Genomic instability is a common feature of cancer etiology. This provides an avenue for therapeutic intervention, since cancer cells are more susceptible than normal cells to DNA damaging agents. However, there is growing evidence that the epigenetic mechanisms that impact DNA methylation and histone status also contribute to genomic instability. The DNA damage response, for example, is modulated by the acetylation status of histone and non-histone proteins, and by the opposing activities of histone acetyltransferase and histone deacetylase (HDAC) enzymes. Many HDACs overexpressed in cancer cells have been implicated in protecting such cells from genotoxic insults. Thus, HDAC inhibitors, in addition to unsilencing tumor suppressor genes, also can silence DNA repair pathways, inactivate non-histone proteins that are required for DNA stability, and induce reactive oxygen species and DNA double-strand breaks. This review summarizes how dietary phytochemicals that affect the epigenome also can trigger DNA damage and repair mechanisms. Where such data is available, examples are cited from studies in vitro and in vivo of polyphenols, organosulfur/organoselenium compounds, indoles, sesquiterpene lactones, and miscellaneous agents such as anacardic acid. Finally, by virtue of their genetic and epigenetic mechanisms, cancer chemopreventive agents are being redefined as chemo- or radio-sensitizers. A sustained DNA damage response coupled with insufficient repair may be a pivotal mechanism for apoptosis induction in cancer cells exposed to dietary phytochemicals. Future research, including appropriate clinical investigation, should clarify these emerging concepts in the context of both genetic and epigenetic mechanisms dysregulated in cancer, and the pros and cons of specific dietary intervention strategies

Histone Deacetylase Inhibitors Selectively Target Homology Dependent DNA Repair Defective Cells and Elevate Non-Homologous Endjoining Activity

Background: We have previously used the ATAD5-luciferase high-throughput screening assay to identify genotoxic compounds with potential chemotherapeutic capabilities. The successful identification of known genotoxic agents, including the histone deacetylase inhibitor (HDACi) trichostatin A (TSA), confirmed the specificity of the screen since TSA has been widely studied for its ability to cause apoptosis in cancer cells. Because many cancers have acquired mutations in DNA damage checkpoints or repair pathways, we hypothesized that these cancers may be susceptible to treatments that target compensatory pathways. Here, we used a panel of isogenic chicken DT40 B lymphocyte mutant and human cell lines to investigate the ability of TSA to define selective pathways that promote HDACi toxicity. Results: HDACi induced a DNA damage response and reduced viability in all repair deficient DT40 mutants although ATM-nulls were least affected. The most dramatic sensitivity was observed in mutants lacking the homology dependent repair (HDR) factor BLM or the non-homologous end-joining (NHEJ) and HDR factors, KU/RAD54, suggesting an involvement of either HDR or NHEJ in HDACi-induced cell death. To extend these findings, we measured the frequencies of HDR and NHEJ after HDACi treatment and monitored viability in human cell lines comparably deficient in HDR or NHEJ. Although no difference in HDR frequency was observed between HDACi treated and untreated cells, HDR-defective human cell lines were clearly more sensitive than wild type. Unexpectedly, cells treated with HDACis showed a significantly elevated NHEJ frequency. Conclusions: HDACi targeting drugs induced significant increases in NHEJ activity in human cell lines but did not alter HDR frequency. Moreover, HDR is required for cellular resistance to HDACi therapy; therefore, NHEJ does not appear to be a critical axis for HDACi resistance. Rather, HDACi compounds induced DNA damage, most likely double strand breaks (DSBs), and HDR proficiency is correlated with cell survivalclose4

Correlation of Pupil Cycle Time and Postural Hypotension as a Marker for Diabetic Neuropathy

Introduction: Diabetic Neuropathy (DN) can involve autonomic nervous system like cardiovascular system and pupillary reflex. Cardiovascular DN can be measured by estimating the change in Blood Pressure (BP) based on position. Ocular DN can be evaluated by using Pupil Cycle Time (PCT), which is an early diagnostic tool to estimate ocular DN. It is a simple way to measure autonomic reflex activity and is a specific test to study parasympathetic function. Aim: To assess the correlation of effects of postural hypotension and PCT on persistent diabetes. Materials and Methods: The prospective cross-sectional study was conducted in Ophthalmology Out Patient Department (OPD) at KS Hegde Medical Academy, Mangalore, Karnataka, India, from January 1st 2019 to December 31st 2019. The study included 60 male patients between the age group of 40-60 years which were divided into two groups of 30 diabetics (Random Blood Sugar (RBS) >200 mg/dL, Fasting Blood Sugar (FBS) >126 mg/dL and Glycated Haemoglobin (HbA1c) >6.5%) and 30 non diabetics. The blood pressure of all the patients were recorded using a sphygmomanometer in sitting and standing positions. PCT was measured in both eyes using Haggstreit-type of slit lamp after the subject was seated in a dimly lit room after dark adaptation for 15 minutes. Results: The mean age of patients in the diabetic group was 54±3.2 years and the non diabetic group was 52±2.7 years. The mean HbA1c of diabetics was 6.9±0.8%. The mean BP among diabetics in standing position was 133.86±29.34 mmHg systolic and 87.4±16.72 mmHg diastolic whereas in sitting position, it was 141.66±28.17 mmHg systolic and 85.26±13.39 mmHg diastolic. The mean BP among non diabetics in standing position was 129.46±24.84 mmHg systolic and 83.46±13.52 mmHg diastolic whereas in sitting position, it was 132.06±26.48 mmHg systolic and 81.26±11.45 mmHg diastolic. The mean PCT-I and PCT-II in diabetics was 1000.52±187.73 and 1006.09±199.45, respectively. The systolic and diastolic BP, both during sitting and standing postures, in diabetic patients were high. The mean PCT-I and PCT-II in non diabetics was 853.23±181.54 and 880.17±192.72, respectively. The PCT-I and PCT-II were found to be significantly high in diabetic patients as compared to controls. The PCT-I and PCT-II negatively correlated with both diastolic and systolic blood pressure in sitting and standing postures. Conclusion: Prolongation of PCT in diabetics correlates significantly with evidence of autonomic neuropathy obtained from testing of postural BP variations. Patients whose cardiovascular reflexes are very abnormal tend to have pupils which cycle slowly

Are You Happy with The Way Your Body Looks in Midlife?

Purpose: The years between 40 to the early 60’s in the human life span is referred to as the Midlife period. It is also considered as an important period in one’s life, referred to as the transition period. By this age it is generally assumed that a person would have more free time in their hands, as they get settled/established in their career and with the children hitting their teens and no longer demanding a lion’s share of their spare time, one is free to socialise, introspect, explore new avenues etc. Traditionally it is believed that people are more fixated or obsessed with their outwardly appearance up until their 40, s and as they hit their midlife, they tend to become more relaxed on their outward appearance and physique. In the current scenario where people are locked up indoors due to the Covid19 pandemic. Working, Socialising, recreation is facilitated by some or the other social media platform. The issue here is that these platforms not only show us the other person, but you see yourself also on screen. Seeing themselves on screen is not something that the people in their midlife are used to. This over exposure of the unfiltered self, pitched against the others on screen make them conscious of their haves and have not’s. The massive boom of the beauty /fitness industry along with the new age/gen Selfie revolution has put a massive pressure on the human psyche to look perfect and flawless in every frame. People have become very aware of their body, body type, flaws and assets.  Objective:  This research was done to Understand the extent to which the people from a fitness group and who follow an exercise regime are conscious about the appearance of their specific body parts.  Design/Methodology/Approach: Quantitative analysis with pre-established tool of body comparison scale. Findings/Results: Results showed that contrary to the general understanding that people become relaxed towards their appearance during their midlife, both, males and females were bothered about their physical features and appearance. Both the genders were equally concerned about size, weight, waist, physique and overall shape. Males were more bothered about the muscular attributes while females were shown to be more conscious about non muscular physical attributes. Hence the results clearly indicated that due to social media influence, people in midlife are really conscious, comparative and critical about their physical attributes and body, irrespective of their gender.  Originality/Value: The study points out at how comparative the social circles make us towards our own bodies.  Paper Type: Quantitative Analysi