Unsuspected Subclinical Left Ventricular Dysfunction in Post-COVID Patients: A Real-world Observation

Background: Subclinical myocardial dysfunction may exist in post-COVID-19 patients and may carry significance in long term. Methodology: Subjects of long-COVID-19 with historically and radiologically significant pulmonary involvement (without documented cardiac involvement) were evaluated on outpatient follow-up echocardiographically when they had disproportionate shortness of breath (SOB), fatigue, or high pulse rate as perceived by the physicians. The common acute-phase symptoms were noted and scored retrospectively. The assessment included spirometry and measurement of chronic obstructive pulmonary disease (COPD) assessment test (CAT) score with measurement of the left ventricular (LV) and right ventricular (RV) free wall global longitudinal strain as an adjunct to routine two-dimensional and Doppler echocardiography and spirometry. The results were evaluated statistically with respect to the history of hospitalization. Results: The hospitalized (n = 15) and nonhospitalized (n = 10) patients were demographically similar. However, the nonhospitalized patients had higher total symptom score (p = 0.03), anosmia (p = 0.017), and ageusia (p = 0.0019). At follow-up (>3 months of acute illness), the nonhospitalized patients had a better CAT score (p = 0.04), higher change in max pulse rate (p = 0.03), and higher forced expiratory volume in 1 second (FEV1) (p = 0.002), tricuspid annular plane systolic excursion (TAPSE) (p = 0.02), and left ventricular global longitudinal strain (LVGLS) (–17.15 ± 1.19 vs –13.11 ± 1.91) (p = 0.0001). Overall, the two groups formed distinct clusters. The LVGLS and the maximum pulse rate difference in the two chair test (2CT) seem to contribute maximally to the variance between the two groups in multivariate analysis. Conclusion: The subclinical myocardial dysfunction persisting in post-COVID patients (without suspected cardiac affection and lower neuroinflammatory symptoms in the acute phase) with significant pulmonary affection needs further evaluation. They demonstrate a higher max pulse rate difference in the 2CT. This real-world observation demands further investigations

Pragmatic Real-world Approach to Treat Diffuse Parenchymal Lung Disease in Logistically Constraint Situations: A Proposition

Understanding the etiology and the tempo of progression with inexorable and self-perpetuating fibrosis [identification of progressive-fibrotic (PF) phenotype of interstitial lung disease (ILD) (PF-ILD)] can help to decide the treatment of diffuse parenchymal lung disease (DPLD) in the real-world practice. An evidence-supported pragmatic approach has been forwarded for such circumstances.

Biological Activity of Essential Oils of two Variant of Cinnamomum Verum Presl. From North East India on Callosobruchus Chinensis (L.).

Callosobruchus chinensis (L.) (Coleoptera: Bruchidae) is one of the major insect pest infesting stored pulses in India. Recourse of synthetic insecticides to protect stored pulses often lead to dangers of the development of resistant strains, toxic residue and users safety. Locally available and less toxic pest management alternatives such as the use of effective botanicals are important. Essential oils of two variants of Cinnamomum verum Presl. Syn. C. zelanicum Blume from North East India (RRL J 1620 and RRL J 1622) were characterized and tested for their biological activity in vapour form against Callosobruchus chinensis (L.). Choice and no-choice tests showed that leaf and bark oil of two variants of C. verum Presl. had significant repellent action and reduced the fecundity and decreased egg hatchability of C. chinenisis (L.). However, leaf oil with higher percentage of eugenol exhibited better activity than the bark oil in both the tests. Hence, the volatile essential oils of both the variants of C. verum Presl. can be used safely as fumigants.

Optimization of cultural conditions affecting growth and improved bioactive metabolite production by a subsurface aspergillus strain TSF 146.

The aim of this study was to optimize cultural conditions for optimum growth and bioactive metabolite production by Aspergillus strain TSF 146, isolated from the subsurface soils of Brahmaputra plains, Assam, India. Agar disc diffusion assay was used to examine the antagonistic activity of the strain. The effect of different culture media, temperature, pH, incubation period, shaking, inoculum size and various carbon and nitrogen sources on the mycelial growth and bioactive metabolite production in a fixed volume of culture broth were studied. Aspergillus strain TSF 146 grew well and produced optimum bioactive metabolites in Potato dextrose broth medium at 25 °C on the 14th day of the incubation. The optimal mycelial growth, however, was obtained at pH 5.5. Sucrose (2.0 g/l) and asparagine (1.0 g/l) were the best carbon and nitrogen sources respectively for optimum growth and production of active metabolites by the isolate. Inoculum size of 2x1010 spores/ml with periodic shaking at 150 rpm optimized production of bioactive molecules. The results of the present investigation indicated that cultural conditions like carbon, nitrogen and mineral sources as well as physical factors such as temperature, pH, incubation period, inoculum size and shaking greatly affected the growth and production of bioactive metabolites by Aspergillus strain TSF 146.

Transthoracic decompression of emphysematous bulla: A novel experience.

Emphysematous bullae are closed air containing spaces in lung parenchyma that may severely compromise lung function in patients of chronic obstructive pulmonary disease (COPD). We describe a simple and minimally invasive procedure to decompress a large emphysematous bullae in a patient with advanced COPD and high surgical risk. Transthoracic decompression of the bulla was accomplished under short-acting anaesthesia and muscle relaxation resulting in significant symptomatic, radiological and functional improvement.

Dengue encephalitis.

Encephalitis is an uncommon manifestation of dengue fever. Here we present a 4-year-old female child from northeastern India with dengue encephalitis. To our knowledge, this is the first reported case of dengue encephalitis from this region.

Symmetric peripheral gangrene of the lower limbs in a case of complicated falciparum malaria.

Association of symmetric peripheral gangrene (SPG) with falciparum malaria infection is a relatively uncommon clinical entity. Here we report a case of complicated falciparum malaria with SPG involving both lower limbs from the mid-calf downwards, probably due to antibody mediated vasculitis.

Immunomodulatory role of arabinosylated lipoarabinomannan on Leishmania donovani infected murine macrophages.

Arabinosylated lipoarabinomannan (Ara-LAM), a surface glycolipid antigen isolated from avirulent Mycobacterium smegmatis is involved in modulation of host cell signaling. In this study, we investigated Ara-LAM-mediated modulation of impaired immune responses during visceral leishmaniasis caused by protozoan parasite Leishmania donovani. Ara-LAM treatment at dose of 3 microg/ml in L. donovani infected murine peritoneal macrophages as well as J774A.1 macrophage cell line exhibited a distinct up-regulation of pro-inflammatory cytokines like TNF-alpha and IL-12 both at the protein and transcriptional level. In addition, generation of nitric oxide and iNOS expression were also observed. The present study showed that Ara-LAM was significantly effective in elimination of L. donovani parasites from both peritoneal as well as J774A.1 macrophages. Thus, it could be utilized as an immunomodulatory agent in prevention of leishmanial pathogenesis.

Emergency in malaria.

Malaria is still the most prevalent and devastating parasitic disease worldwide. In recent years drug resistance Plasmodium falciparum malaria has returned to most of the tropical countries of the globe with a vengeance. Due to various atypical manifestations the diagnosis has become confusing and hence the treatment delayed leading to various complications and increased mortality and morbidity. Patient presents with features of severe complicated malaria with multiorgan involvement in the form of malarial crisis needs emergency management in ICU. All fever cases with possible malaria should be investigated and to be treated with intravenous quinine/artimisinine pending confirmation of diagnosis. Any emergency situation that develops during treatment should be treated aggressively as medical emergency.

Transmission of malaria and its control in the northeastern region of India.

Let alone the eradication, malaria control itself has amounted to be a challenge, and is detrimental to the all round development of the northeastern region of India. Focal outbreaks are frequent taking heavy tool on human lives. Plasmodium falciparum is the predominant parasite species and is solely responsible for increased morbidity and mortality. The region contributes bulk of P. falciparum cases for the rest of India, and its proportions are increasing. Efficient vectors like Anopheles minimus, Anopheles fluviatilis and Anopheles dirus persistently support transmission of malaria. The present review gives a comprehensive account of the factors responsible for transmission of the disease with focus on vector bionomics, its prevention and control.

Primary orbital lymphoma.

Primary orbital lymphoma is a rare condition involving primarily the lacrimal glands. We present the second Indian case of right-sided primary orbital lymphoma in an elderly male who presented with the typical features and showed a good response to chemotherapy.

Current recommendations of chemotherapy and pharmacology of antituberculosis drugs.

Due to presence of natural mutant bacilli, existence of the bacilli in several populations and in various sites, combination of two, three or more drugs is necessary to treat tuberculosis and that too for a long time. Inadequate therapy leads to relapse and treatment failure. The cumulative effect of negligence, mistakes and new threats (e.g., HIV infection) has made the treatment difficult today. The National Tuberculosis Control Programme of 1962 has been modified recently by Revised National Tuberculosis Control Programme. The targets are to detect at least 70% of new smear positive cases and to achieve at least 85% cure rate by Directly Observed Therapy Short course (DOTS). Categorisation of patients and treatment recommendations are discussed along with pharmacology of antituberculosis drugs.

Role of bone marrow and thymus secretory protein in maintaining immune homeostasis and haemopoiesis in control and malnourished mice.

Injection of Salmonella typhi 'H' antigen was observed to produce a differential effect on bone marrow and thymus secretory profile depending upon the nutritional status of the host. The paracrine effect of Thy F1 (thymus fraction 1) was more significant (P < 0.01) than the autocrine effect of BIM (Bone marrow immunomodulator) in malnourished mice. BIM moreover, also had a paracrine effect on thymus irrespective of the nutritional status of the host. An improvement in neutrophil population (P < 0.01) and phagocytic myeloperoxidase activity (P < 0.01) was observed in BIM treated malnourished immuno-suppressed mice, whereas no appreciable change was observed by Thy F1. However, Thy F1 irrespective of the nutritional status of the host improved large lymphocyte population in circulation (P < 0.01). These findings indicate that both bone marrow and thymus play a major role in haemopoietic microenvironment of BDF (basal diet fed) control and malnourished mice.

Anti-implantation effect of a bone-marrow cytokine-BIM.

Successful implantation of blastocyst is dependent upon a cytokine induced localized immunosuppression at uterus. BIM, a bone marrow secreted bio-immunomodulator (BIM) has been observed to have positive immunomodulatory activity in immunosuppressed cases. As pregnancy is associated with immunosuppression upregulation of the suppressed immune system by injection of BIM (conc. 0.08 microg/g b.wt once in rats b.wt. <150 gm or 0.2 microg/g b.wt thrice in rats weighing > 160 gm) is believed to prevent implantation. The anti-implantation action of BIM is probably mediated via mononuclear cells at site of uterus, the effect is reversible and a single dose did not affect the estrous cycle. Multiple dose of BIM however, produce prolonged diestrous and this is probably an autonomic phenomena.

Hepatoprotective effect of a protein isolated from Cajanus indicus (Spreng) on carbon tetrachloride induced hepatotoxicity in mice.

Treatment with hepatotoxin namely carbon tetrachloride (CCl4) (0.1 ml/100 g of body weight; twice a week) induced acute hepatic necrosis in Swiss albino mice (male; body weight 30 g +/- 2), with significant alteration in the activities of glutamic oxaloacetic transaminase (GOT); glutamic pyruvic transaminase (GPT); alkaline phosphatase (AP) and serum bilirubin. Administration of a protein fraction isolated from the leaves of C. indicus counteracted the action of CCl4 on transaminase, phosphatase showing hepatoprotection. Daily treatment with a purified protein fraction 'X' from the above plant (0.5 mouse ml i.p; 50-60 micrograms/ml) for a period of 7, 14, 21 days respectively showed decreased activities of serum transaminases alkaline phosphatase and decreased levels of serum bilirubin. These findings were further confirmed by histopathological study of liver.

Pancreatic beta cell function in normoglycaemic offspring of diabetic parents.

The aim of the study was to look for any time-realted fluctuation in the pancreatic beta cell function in normal offspring of diabetic parents, over a period of three years. Serum insulin (IRI) and C-peptide (CP) responses to oral glucose were reevaluated three years after the initial study in 25 normoglycaemic offspring of conjugal Type 2 diabetic parents. The mean area under the curve of IRI (AUC IRI) response was higher than normal control value in the offspring at both time points (P < 0.01) and the two values did not differ much. The 2 hr IRI was also significantly higher (P < 0.05) than the control value. CP responses at both time points in the offspring did not differ from the mean control value. Wide fluctuations in the individual IRI were noted on follow-up despite similar plasma glucose response. Follow-up IRI was higher in 6, lower in 5 (+/- 25% of the initial) and remained unaltered in the other 4 offspring. The corresponding CP showed increased values in 3, decreased values in 5 and no change in 7 offspring. The fluctuations were nonuniform in nature among the individuals studied. Disparity between the IRI and CP responses were present in 5 offspring during the follow-up. This study thus shows that wide fluctuations in insulin responses occur even in the normoglycaemic offspring of diabetic parents.