Rare Manifestation of Diabetes Mellitus in COVID-19 Patient: A Case Report

Background: Diabetes is an endocrinopathy and rare in the case of SARS-CoV-2, the virus primarily involves the lungs by its affinity to Angiotensin Converting enzyme(ACE-2) receptors, associated symptoms include Nausea, Vomiting, and Breathlessness. Case Presentation: We present the case of a 41-year-old male with pneumonia-like symptoms and a positive nasal swab RT-PCR test with Imaging studies highly suggestive of CO RADS-5 Progressive stage, the patient was immediately admitted to the Intensive care unit (ICU), and the treatment was started with Medical Oxygen, Intravenous Normal Saline Tablet Doxycycline, and Tablet Ivermectin as per the guidelines, he was admitted for 21 days. After 3 weeks the patient comes for a routine checkup and was found to have an elevated Fasting glucose level of 121 mg/dl (normal reference range 80-100mg/dl) further workup for diabetes revealed that he was a non-diabetic on the previous visit 2 months ago, he also had an increase in weight during this time. With the Body Mass Index(BMI) now being 30.2 from the previous 28.4 (Reference range >30 is obese), the pro-inflammatory cytokines like C-reactive protein were 111.6 (normal 0-6), and elevation in D-Dimer which is a fibrin degradation product was elevated to 1048ng/dl ( normal range 0-500 ng/dl) other measures for the increase in blood sugar also showed elevation as seen in table 1. Discussion: There have been many hypotheses to find a causal relationship between both Diabetes and Covid-19 like the use of Dexamethasone or that the virus produces proinflammatory cytokines like Interleukin-6(IL-6) that lead to impaired signaling and decreased lipolysis or that there is a direct action on the ACE 2 found in the pancreas by the virus and maybe the least looked upon factor being lockdown leading to sedentary life, no exercises and increase in consumption of fatty foods, whichever may be the case it could very well be a multifactorial cause with many of these ideas involved.  Conclusion: In this case, the association may be with decreased physical activity and an increase in Lipolysis or the proinflammatory states as seen by the increase in the C-reactive protein and Interleukin-6 levels. Table:  Parameter Values before COVID Values after Covid Reference range Total WBC 4900 11,400 4000-10000/cu.mm Platelet count 200000 450000 140000-440000/cu.mm C-reactive protein 1.55 111.6 0-6 D-Dimer 0.4 1048 0-500 ng/dl Interleukin (IL-6) - 97.42 <10 Serum Cholesterol 127 220 130-200mg/dl Alanine transaminase - 54 6-45 Serum Creatinine - 1.04 0.50-1.50 Random blood sugar 89 143 70-140mg/dl HbA1C - 7.40 4.3-6.2 Mean blood glucose - 174.30 70-100mg/dl Fasting Blood sugar 92 121 <100mg/dl Post Prandial Blood sugar 120 159 <140mg/dl Table 1 : Laboratory values before and after COVID-19

The universality of black hole thermodynamics

The thermodynamic properties of black holes -- temperature, entropy and radiation rates -- are usually associated with the presence of a horizon. We argue that any Extremely Compact Object (ECO) must have the {\it same} thermodynamic properties. Quantum fields just outside the surface of an ECO have a large negative Casimir energy similar to the Boulware vacuum of black holes. If the thermal radiation emanating from the ECO does not fill the near-surface region at the local Unruh temperature, then we find that no solution of gravity equations is possible. In string theory, black holes microstates are horizonless quantum objects called fuzzballs that are expected to have a surface $\sim l_p$ outside $r=2GM$; thus the information puzzle is resolved while preserving the semiclassical thermodynamics of black holes.Comment: 14 pages, 3 figures, (Essay awarded third prize in the 2023 Gravity Research Foundation essay competition); Some typos correcte

A vulval leiomyoma: a rare camouflaging tumor

Uterine leiomyomas are a benign tumor of human uterus and common problem in gynecology. Despite this, leiomyomas of the vulva are rare, masquerading, and usually misdiagnosed as Bartholin cyst preoperatively. These benign smooth muscle tumors are typically painless, solitary, and well circumscribed and can affect female of any age group. We hereby present a case of a 39-year-old female that presented in OPD at ESIC model hospital, Bapunagar, Ahmedabad with left labial mass and was misdiagnosed as Bartholin cyst initially and later on histopathology final diagnosis of vulvar leiomyoma was made

Lifting of two-mode states in the D1-D5 CFT

We consider D1-D5-P states in the untwisted sector of the D1-D5 orbifold CFT where one copy of the seed CFT has been excited by a pair of oscillators, each being either bosonic or fermionic. While such states are BPS at the orbifold point, they will in general `lift' as the theory is deformed towards general values of the couplings. We compute the expectation value of this lift at second order in the deformation parameter for the above mentioned states. We write this lift in terms of a fixed number of nested contour integrals on a given integrand; this integrand depends on the mode numbers of the oscillators in the state. We evaluate these integrals to obtain the explicit value of the lift for various subfamilies of states. At large mode numbers one observes a smooth increase of the lift with the dimension of the state $h$; this increase appears to follow a $\sim \sqrt{h}$ behavior similar to that found analytically in earlier computations for other classes of states.Comment: 40 pages, 9 figures; v2 minor typos fixe

Flavour Enhanced Food Recommendation

We propose a mechanism to use the features of flavour to enhance the quality of food recommendations. An empirical method to determine the flavour of food is incorporated into a recommendation engine based on major gustatory nerves. Such a system has advantages of suggesting food items that the user is more likely to enjoy based upon matching with their flavour profile through use of the taste biological domain knowledge. This preliminary intends to spark more robust mechanisms by which flavour of food is taken into consideration as a major feature set into food recommendation systems. Our long term vision is to integrate this with health factors to recommend healthy and tasty food to users to enhance quality of life.Comment: In Proceedings of 5th International Workshop on Multimedia Assisted Dietary Management, Nice, France, October 21, 2019, MADiMa 2019, 6 page

Universal lifting in the D1-D5 CFT

We consider D1-D5-P states in the untwisted sector of the D1-D5 orbifold CFT where one copy of the seed CFT has been excited with a left-moving superconformal primary. Despite being BPS at the orbifold point, such states can `lift' as the theory is deformed away from this point in moduli space. We compute this lifting at second order in the deformation parameter for arbitrary left-moving dimension $h$ of this class of states. This result displays an interesting universality since the lifting does not depend on the details of the superconformal primary; it depends only on the dimension. In the large-dimension limit the lift scales as $\sqrt{h}\,$; it is observed that such scaling appears to be a universal property of the lift of D1-D5-P states.Comment: 36 pages, 1 figur

Gastric IgG4-Related Autoimmune Fibrosclerosing Pseudotumour: A Novel Location

We describe the first reported case of an IgG4-related autoimmune fibrosclerosing pseudotumour located in the stomach of a 75-year old woman presenting with weight loss and vomiting. A lesion was detected in the gastric body at endoscopy. Subsequent characterisation by CT was suggestive of a gastrointestinal stromal tumour. Following laparoscopic resection, the patient recovered uneventfully. Histological examination of the resected specimen revealed an IgG4-related fibrosclerosing pseudotumour, a novel location for this histopathological entity

A cohort study of 4,190 patients treated with low-intensity pulsed ultrasound (LIPUS): findings in the elderly versus all patients

BACKGROUND: Patient age is one of many potential risk factors for fracture nonunion. Our hypothesis is that older patients (≥ 60) with fracture risk factors treated with low-intensity pulsed ultrasound (LIPUS) have similar heal rate (HR) to the population as a whole. We evaluate the impact of age in conjunction with other risk factors on HR in LIPUS-treated patients with fresh fracture (≤ 90 days old). METHODS: The Exogen Bone Healing System is a LIPUS device approved in 1994 to accelerate healing of fresh fracture. After approval, the FDA required a Post-Market Registry to assess performance. Patient data collected from October 1994 until October 1998 were individually reviewed and validated by a registered nurse. Four distinct data elements were required to report a patient: date fracture occurred; date treatment began; date treatment ended; and a dichotomous outcome of healed v. failed, by clinical and radiological criteria. Data were used to calculate two derived variables; days to treatment (DTT) and days on treatment (DOT). Every validated fresh fracture patient with DTT, DOT, and outcome is reported. RESULTS: The validated registry had 5,765 patients with fresh fracture; 73% (N = 4,190) are reported, while 13% of patients were lost to follow-up, 11% withdrew or were non-compliant, and 3% died or are missing outcome. Among treatment-compliant patients, HR was 96.2%. Logistic estimates of the odds ratio for healing are equivalent for patients age 30 to 79 years and all age cohorts had a HR > 94%. Open fracture, current smoking, diabetes, vascular insufficiency, osteoporosis, cancer, rheumatoid arthritis, and prescription NSAIDs all reduced HR, but older patients (≥ 60) had similar HRs to the population as a whole. DTT was significantly shorter for patients who healed (p < 0.0001). CONCLUSIONS: Comorbid conditions in conjunction with aging can reduce fracture HR. Patients with fracture who used LIPUS had a 96% HR, whereas the expected HR averages 93%. Time to treatment was significantly shorter among patients who healed (p < 0.0001), suggesting that it is beneficial to begin LIPUS treatment early. Older patients (≥ 60) with fracture risk factors treated with LIPUS exhibit similar heal rates to the population as a whole

Survival and Functional Outcomes After Hip Fracture Among Nursing Home Residents

Importance Little is known regarding outcomes after hip fracture among long-term nursing home residents. Objective To describe patterns and predictors of mortality and functional decline in activities of daily living (ADLs) among nursing home residents after hip fracture. Design, Setting, and Participants Retrospective cohort study of 60 111 Medicare beneficiaries residing in nursing homes who were hospitalized with hip fractures between July 1, 2005, and June 30, 2009. Main Outcomes and Measures Data sources included Medicare claims and the Nursing Home Minimum Data Set. Main outcomes included death from any cause at 180 days after fracture and a composite outcome of death or new total dependence in locomotion at the latest available assessment within 180 days. Additional analyses described within-residents changes in function in 7 ADLs before and after fracture. Results Of 60 111 patients, 21 766 (36.2%) died by 180 days after fracture; among patients not totally dependent in locomotion at baseline, 53.5% died or developed new total dependence within 180 days. Within individual patients, function declined substantially after fracture across all ADL domains assessed. In adjusted analyses, the greatest decreases in survival after fracture occurred with age older than 90 years (vs ≤75 years: hazard ratio [HR], 2.17; 95% CI, 2.09-2.26 [P \u3c .001]), nonoperative fracture management (vs internal fixation: HR for death, 2.08; 95% CI, 2.01-2.15 [P \u3c .001]), and advanced comorbidity (Charlson score of ≥5 vs 0: HR, 1.66; 95% CI, 1.58-1.73 [P \u3c .001]). The combined risk of death or new total dependence in locomotion within 180 days was greatest among patients with very severe cognitive impairment (vs intact cognition: relative risk [RR], 1.66; 95% CI, 1.56-1.77 [P \u3c .001]), patients receiving nonoperative management (vs internal fixation: RR, 1.48; 95% CI, 1.45-1.51 [P \u3c .001]), and patients older than 90 years (vs ≤75 years: RR, 1.42; 95% CI, 1.37-1.46 [P \u3c .001]). Conclusions and Relevance Survival and functional outcomes are poor after hip fracture among nursing home residents, particularly for patients receiving nonoperative management, the oldest old, and patients with multiple comorbidities and advanced cognitive impairment. Care planning should incorporate appropriate prognostic information related to outcomes in this population