Assessment of Post-Traumatic Stress Disorder in Patients Who Recovered from COVID-19

Background: It is essential to address psychological health, particularly post-traumatic stress disorder (PTSD), among patients who have recovered from COVID-19. The negative impacts on the psychological health of an individual have negative impacts on health-related quality of life. The authors aimed to assess PTSD in patients recovered from COVID-19, and COVID-19-related comorbidities. Methodology: The present study was conducted as an observational cross-sectional study on patients diagnosed with COVID-19 who were discharged from Gandhi Medical College and Hamidia Hospital, both in Bhopal, India, and returning to follow-up at the medicine/psychiatry outpatient department within 6 months after discharge, during the study period of 20 months. Detailed history regarding sociodemographic variables, previous medical history, comorbidities associated with COVID-19 (e.g., mucormycosis, etc.) were noted. PTSD was assessed using the PTSD Symptom Scale (PSS). Results: A total of 120 cases, who recovered from COVID-19 infection and sought care at the authors’ centre, were included in this study, with mean age of 37.520±12.756 years. Mean PTSD score was 3.350±1.528, and PTSD was noted in 85% cases. Of these, 83.3% cases had mild, and 1.7% cases had moderate PTSD. The authors observed no significant association of sociodemographic variables with PTSD on univariate as well as multivariate analysis (p>0.05). Conclusions: Though the wave of COVID-19 pandemic has subsided, the long-term morbidities, particularly due to the impact on psychological health, are still persistent. PTSD is a common consequence following recovery from COVID-19 infection. Thus, mental health services must be provided to patients recovered from COVID-19 infection, mainly targeted at prevention of PTSD

Study of cardiac dysfunctions in chronic liver disease patients

Background: Cardiac dysfunctions are a major cause of mortality in chronic liver disease patients, especially those who undergo surgical procedures like TIPS, LT. Aims and Objectives: The present study aimed to determine the prevalence of cardiac dysfunctions in chronic liver disease patients. Methodology: The present study was conducted as an observational study at Hamidia Hospital Bhopal. The study included a total of 75 patients diagnosed as a case of chronic liver disease who were then interviewed and their demographic information and symptoms and presentation was obtained. All the patients were then subjected to detailed physical examination, cardiological assessment using ECG and 2D ECHO and blood investigations. Results: The Mean age of patients without Cardiac dysfunction was 40.3 years, whereas the Mean age of patients with Cardiac dysfunction was 46.25 years. Cardiac dysfunctions in CLD patients most commonly occurred in age group of 51-60 years and 96% cases were males and only 4% cases were females. QTc prolongation was found in 28% of patients. The prevalence of Diastolic Dysfunctions was 24% and the prevalence of Systolic Dysfunctions in CLD patients was 20 %. Conclusion: Subclinical cardiac dysfunctions are present in a significantly large number of patients with Chronic liver disease. These dysfunctions are associated with more cardiovascular complications especially when these patients are subjected to surgical procedures such as TIPS, liver transplantation. Hence there is a need for a comprehensive cardiac assessment and standardized diagnostic protocol for patients of liver cirrhosis, especially undergoing procedures such as TIPS, liver transplantation

Modeling Plasma-to-Interstitium Glucose Kinetics from Multitracer Plasma and Microdialysis Data

Background: Quantitative assessment of the dynamic relationship between plasma and interstitial fluid (ISF) glucose and the estimation of the plasma-to-ISF delay are of major importance to determine the accuracy of subcutaneous glucose sensors, an essential component of open- and closed-loop therapeutic systems for type 1 diabetes mellitus (T1DM). The goal of this work is to develop a model of plasma-to-ISF glucose kinetics from multitracer plasma and interstitium data, obtained by microdialysis, in healthy and T1DM subjects, under fasting conditions. Materials and Methods: A specific experimental design, combining administration of multiple tracers with the microdialysis technique, was used to simultaneously frequently collect plasma and ISF data. Linear time-invariant compartmental modeling was used to describe glucose kinetics from the tracer data because the system is in steady state. Results: A two-compartment model was shown accurate and was identified from both plasma and ISF data. An “equilibration time” between plasma and ISF of 9.1 and 11.0 min (median) in healthy and T1DM subjects, respectively, was calculated. Conclusions: We have demonstrated that, in steady-state condition, the glucose plasma-to-ISF kinetics can be modeled with a linear two-compartment model and that the “equilibration time” between the two compartments can be estimated with precision. Future studies will assess plasma-to-interstitium glucose kinetics during glucose and insulin perturbations in both healthy and T1DM subjects

Effects of transaldolase exchange on estimates of gluconeogenesis in type 2 diabetes

13 C]acetate during a separate visit in a subset of ND (n ϭ 7) subjects. Ratio of 13 C3/ 13 C4 obtained following either tracer was Ͻ1.0 at baseline and during clamp, indicating that TPI exchange was essentially complete and did not contribute to asymmetric glucose enrichment. Uncorrected and corrected rates of gluconeogenesis were no different (P ϭ not significant) in T2DM vs. ND both at baseline and during clamp. TA correction resulted in equivalent estimates of corrected gluconeogenesis in T2DM and ND that were ϳ25-35% lower than uncorrected gluconeogenesis both at baseline and during the clamp. The asymmetric enrichment of glucose from 13 C-gluconeogenic tracers is attributable to TA exchange and can be utilized to correct for TA exchange. In conclusion, TA exchange does not differ between T2DM and ND under fasting or hyperglycemic clamp conditions, and the 2 H2O method continues to provide an accurate estimation of gluconeogenesis. gluconeogenesis; deuterated water; transaldolase; triose phosphate isomerase AFTER AN OVERNIGHT FAST, plasma glucose is not symmetrically labeled from gluconeogenic carbon tracers such as [U- 13 C] glycerol (21) and [3-14 C]lactate (25). Exchange of fructose 6-phosphate and triose phosphate mediated by transaldolase has been implicated by us (3, 7, 9) and others (12) in overestimation of rates of gluconeogenesis, utilizing the deuterated water method. In this method, glucose derived from glycogenolysis (GGL) via glucose 6-phosphate (G6P) source can become labeled in carbons 4, 5, and 6 from either a carbonlabeled gluconeogenic precursor or deuterated water independent of gluconeogenesis. This results in an overestimation of the gluconeogenic fraction and a corresponding underestimation of the glycogenolytic contribution to endogenous glucose production. This exchange is particularly important in the study of type 2 diabetes mellitus (T2DM) since it mimics the characteristic shift toward increased hepatic gluconeogenic activity during the progression of this disease. With a few exceptions (14), stable isotope tracer studies indicate an increased fractional gluconeogenesis in overnight-fasted T2DM subjects compared with healthy nondiabetic (ND) controls 13 C]acetate infusion under conditions of fasting and during a hyperglycemic moderate-dose insulin clamp to determine whether or not TA exchange activity explains differences in glucose enrichment from gluconeogenic substrates between ND and T2DM subjects. We have demonstrated that TA activity occurs in healthy humans based on a higher enrichment of glucose carbon 4 over carbon 3 (i.e., C]acetate (3). In this study, the asymmetric labeling of glucose from this tracer could also be explained by incomplete exchange of the label between glyceraldehyde 3-phosphate and dihydroxyacetone phosphate mediated by incomplete triose phosphate isomerase (TPI; see Therefore, we also compared the 13 C enrichment of glucose from [1- 13 C]acetate and [U-13 C]glycerol in a subset of ND subjects to determine the extent to which asymmetric glucose C3 and C4 enrichments are determined by incomplete TPI exchange and by TA exchange