Acute onset sleep apnea with severe transient hyperglycemia in young adult: the diagnostic dilemma and management controversy

Sleep disordered breathing and obstructive sleep apnea are frequently associated with hyperglycemic disorders. The common pathophysiological factors that link these disorders have been a matter of debate and current research. Abdominal adiposity and high body mass index are considered to predispose individuals to early onset of type 2 diabetes and related metabolic disorders. A young adult presenting with symptoms of obstructive sleep apnea often poses a diagnostic challenge for clinicians especially when multiple risk factors coexist. It is essential to establish the exact diagnosis so that specific treatment can be initiated. The role of a non-aggressive approach in management of severe hyperglycemic conditions has been doubted. We report a case of a 33 year old man presenting to the respiratory outdoor clinic for recent onset loud snoring and increased daytime sleepiness. Routine biochemistry reports revealed hyperlipidemia and severe hyperglycemia. The patient was ambulatory and stable throughout. The subsequent investigations identified multiple stressors and the possibility of a single cause was analysed. A rapid glycemic control and amelioration of symptoms were observed based on consistent monitoring and a conservative clinical approach. The key findings and relevant review of literature are discussed in this article

A high risk unstable case of left main bifurcation lesion treated with simultaneous kissing stents as salvage procedure

Bifurcation treatment with percutaneous coronary intervention is still one challenging task especially the left main bifurcation. And it becomes still more challenging when it is done in emergency situation in a very unstable patients. There are many one-stent and two-stent approaches available to treat the bifurcation lesions but no approach has proven superior to other. Here, we present a case of a 78-year-old male diagnosed with distal left main bifurcation lesion treated with simultaneous kissing stents technique presented with acute coronary syndrome, non-ST elevation myocardial infarction with pulmonary oedema in cardiogenic shock

Tubercular Osteomyelitis of the Orbit Presenting as Periorbital Cellulitis

Purpose: Osteomyelitis of the orbital bones presenting as an orbital cellulitis is a rare form of extrapulmonary tuberculosis (TB). We report a rare case of tubercular osteomyelitis of the orbital bones presenting as a periorbital cellulitis. Case Report: A seven-year-old female child presented to our tertiary eye care center with swelling involving the right eyelids and the right cheek for two months. She had been provisionally diagnosed elsewhere as pre-septal cellulitis and had been given oral antibiotics. We clinically diagnosed her as orbital cellulitis, but her non-responsiveness to intravenous antibiotics prompted us to get a contrast enhanced computed tomography (CECT) of the orbit and paranasal sinuses, which was suggestive of tubercular etiology. However, the patient had no foci for TB elsewhere. We used a relatively new, but rapid test, called Cartridge-based Nucleic Acid Amplification Test (CBNAAT) on the pus aspirate which was positive for TB. Thereafter, the patient was started on anti-tubercular treatment to which she responded wonderfully. Conclusion: A high index of suspicion should be kept for TB infection in cases of orbital cellulitis with unusual clinical behavior in an endemic region such as India

Effect of hydroxychloroquine in viral clearance in nCOV-19 infected patient admitted in tertiary care centre, Ranchi, Jharkhand, India

Background: In view of recent publications of conflicting evidence on the safety and efficacy of hydroxychloroquine as prophylaxis and as a treatment for COVID-19 patients, we need to assess the effect of hydroxychloroquine in COVID-19 patients of authors own local population.Methods: In this retrospective chart review study, categorization of confirmed COVID-19 cases nasopharyngeal swab of RT-PCR was done into a group of patients who received hydroxychloroquine standard dose and another control group who did not receive hydroxychloroquine. The main comparing parameter was to see virus clearance days across both groups.Results: A total of 112 patients were included for the study, and grouped of 72 patient who received HCQS and remaining 40 patients as control. The virus clearance time in days was found to be 9.01±3.08 for HCQS group and for control group it was 8.64±2.34 days (Man Whitney U test value = 2.13, p=0.756).Conclusions: There is no significant difference found in attaining virus negative status with use of HCQS administration in this study

Upcoming 4m ILMT facility and data reduction pipeline testing

peer reviewedThe 4m international liquid mirror telescope (ILMT) installation activities have recently been completed at the Devasthal observatory (Uttarakhand, India). The ILMT will perform continuous observation of a narrow strip of the sky (∼ 27′) passing over the zenith in the SDSS g′, r′ and i′ bands. In combination with a highly efficient 4 k × 4 k CCD camera and an optical corrector, the images will be secured at the prime focus of the telescope using the time delayed integration technique. The ILMT will reach ∼ 22.5 mag (g′-band) in a single scan and this limiting magnitude can be further improved by co-adding the nightly images. The uniqueness of the one-day cadence and deeper imaging with the ILMT will make it possible to discover and study various galactic and extra-galactic sources, specially variable ones. Here, we present the latest updates of the ILMT facility and discuss the preparation for the first light, which is expected during early 2022. We also briefly explain different steps involved in the ILMT data reduction pipeline

Safe practices for legitimate medical use of opioids: a study of trends in opioids prescription over a decade

Background: An unwavering availability of opioids is crucial for effective pain and palliative care and for managing opioid dependence. This study aims to study the pattern of morphine consumption and the use of safety protocols for prescribing opioids in a tertiary cancer hospital in India. Patients and methods: We studied the medical and pharmacy records retrospectively, to investigate the pattern of oral Morphine consumption and distribution from 2008 to 2020. Results: The number of new cancer patients visiting the hospital, the number of re-visits of these patients, and inpatient admissions to palliative care service increased unswervingly from 2008 to 2019 with a sharp fall in 2020 owing to the COVID pandemic. Annual oral morphine consumption showed a steady increase from 4.89 kgs in 2008 to 11.53 kgs in 2019 with a fall to 5.68 kgs in 2020. However, the trend for oral morphine dispensed per patient per visit showed a mild increase from 1.1 gram in 2008 to 2.06 grams in 2012, followed by a gradual decline to 0.89 grams in 2020. Opioid diversion incidence was found to be zero. Conclusions: Comprehensive interventions alongside safety protocols for prescriptions of opioids and effective integration of palliative care can help prevent opioid use disorders

The Long-Baseline Neutrino Experiment: Exploring Fundamental Symmetries of the Universe

The preponderance of matter over antimatter in the early Universe, the dynamics of the supernova bursts that produced the heavy elements necessary for life and whether protons eventually decay --- these mysteries at the forefront of particle physics and astrophysics are key to understanding the early evolution of our Universe, its current state and its eventual fate. The Long-Baseline Neutrino Experiment (LBNE) represents an extensively developed plan for a world-class experiment dedicated to addressing these questions. LBNE is conceived around three central components: (1) a new, high-intensity neutrino source generated from a megawatt-class proton accelerator at Fermi National Accelerator Laboratory, (2) a near neutrino detector just downstream of the source, and (3) a massive liquid argon time-projection chamber deployed as a far detector deep underground at the Sanford Underground Research Facility. This facility, located at the site of the former Homestake Mine in Lead, South Dakota, is approximately 1,300 km from the neutrino source at Fermilab -- a distance (baseline) that delivers optimal sensitivity to neutrino charge-parity symmetry violation and mass ordering effects. This ambitious yet cost-effective design incorporates scalability and flexibility and can accommodate a variety of upgrades and contributions. With its exceptional combination of experimental configuration, technical capabilities, and potential for transformative discoveries, LBNE promises to be a vital facility for the field of particle physics worldwide, providing physicists from around the globe with opportunities to collaborate in a twenty to thirty year program of exciting science. In this document we provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess.Comment: Major update of previous version. This is the reference document for LBNE science program and current status. Chapters 1, 3, and 9 provide a comprehensive overview of LBNE's scientific objectives, its place in the landscape of neutrino physics worldwide, the technologies it will incorporate and the capabilities it will possess. 288 pages, 116 figure