Differences in COVID-19 mortality in males and females: Is estrogen hormone attributing to sex differences?

Objectives: Globally, the case fatality ratio is more in males versus females. Some studies have suggested estrogen hormone decreases susceptibility to SARS CoV-2. We have analyzed the observed sex differences in COVID-19 behavior in males and females and the clinical profiles of females of different age groups of COVID-19 patients and discussed their symptoms, laboratory evaluations, and associated comorbidities. Material and Methods: The patients were tested for COVID-19 through real-time RT-PCR (Reverse Transcription Polymerase Chain Reaction) assay. The data obtained were studied for the epidemiological, clinical, and laboratory characteristics from their medical records. Results: The mortality rate in females was 12.33% (36/292) whereas mortality in males was 19.63% (84/428). In between group analysis, 8.7% (14/161) of females died in the <40 years age group versus 16.8% (22/131) in more than 40 years age group whereas in males, the mortality was 13.7% (21/153) in <40 years versus 22.9%(63/275). The mortality rate in women older than 40 years was greater than mortality in younger females emphasizing the protection provided by estrogen hormone in them. The proportion of patients who expired due to COVID-19 significantly differs by age cutoff of 40 years, X2 (1, n = 428). The difference is statistically significant at P < 0.05. Males more than 40 years are more likely to expire. Conclusion: Sex-related differences in coronavirus pandemic have been found pointing toward the protective role of estrogen hormone and other differences in immunological behavior in males and females. Downregulation of ACE2 expression, thereby reducing viral entry, might also be contributory to decreasing mortality in females.

Knowledge, attitude, and practice toward antibiotic usage among general practitioners: A cross-sectional study

Background: In the developing countries like India, infections are still very common. About 50% of the patients presenting to general practitioners had fever as the complaint pointing that infective ailments still predominate. Aims and Objectives: The use of antimicrobials is very common in practice that leads to the development of antimicrobial resistance. Materials and Methods: A total of 120 GP’s were registered for the present study. Assessment was done based on the special questionnaire prepared for assessing the knowledge, attitude, and practice (KAP) of the GP’s. Results: Data were collected from the Google Forms, which was then analyzed using Statistical software. No statistical difference between KAP of all pathies was observed. There is a statistically significant positive correlation between number of patients attended per day and antibiotics prescribed. This correlation is strong between allopathy practitioners whereas it’s moderate in homeopathy and Ayurveda practitioners. There is a statistically significant association between KAP. Conclusion: Self-medication and modification in the treatment by the patients; unnecessary and improper use by physicians and pharmacists themselves giving antimicrobials without prescription are some of the common problems in irrational use of antimicrobials. From this study, we can conclude that KAP of GP’s has an association with usage of antibiotics and thus programs for promoting and improving KAP’s can be useful in managing the irrational use of antibiotics.

Study of the clinical profile and upper gastrointestinal endoscopic findings in patients with chronic kidney disease

Background: Uremic milieu associated with chronic kidney disease (CKD) is associated with upper gastrointestinal (GI) symptoms such as nausea, vomiting, anorexia, and GI bleeding. Objective: The present study intended to ascertain the prevalence of various upper GI (UGI) symptoms and UGI endoscopic abnormalities in patients of CKD. Materials and Methods: Patients were stratified according to glomerular filtration rate and their respective GI symptoms score was determined and they were subjected to UGI endoscopy. Results: Thirty males and 24 females of CKD were compared with equal number of control group who have normal kidney function but may or may not have UGI disturbance. The severity of CKD correlated with high GI symptom score with maximum number of patients in dialyzed CKD subgroup. Anorexia followed by nausea and abdominal pain was dominant symptoms in the study group. On endoscopic evaluation, hiatus hernia and duodenitis were significantly more prevalent in the study group over the control group. Conclusion: Based on these observations, this study supports the routine usage of UGI endoscopy in evaluation of CKD patients.

Myriad manifestations of dengue fever: Analysis in retrospect

Background: Dengue is a viral disease which has grown dramatically over the years and has emerged as a public health issue requiring intervention to curb its spread. Favorable environment, abundance of vector, and lack of hygiene are leading to unprecedented spread of the disease. Objectives: The objectives were to study the prevalence of various manifestations of dengue fever. Materials and Methods: The study was conducted at Sarojini Naidu Medical College, Agra, during the outbreak from August to November 2015. During the study period, we observed a total of 131 patients. The serology included dengue immunoglobulin (Ig)-M, IgG, and non-structural protein 1 antigen. This study is a hospital-based retrospective study. All the data were expressed in percentage. Results: In this study, we found that cutaneous manifestation was seen in 22.9%, bleeding manifestation in 21.37%, polyserositis in 20.61%, fever in all patients 100%, thrombocytopenia platelet count <10,000 in 71.67%, organomegaly in 25.19%, and gallbladder wall thickening in 6.1%. Atypical manifestation such as hepatic coma, acute respiratory distress, seizure, and chest pain (myocarditis) was also seen in some patients. In this study, 62.59% affected patients were young male in the age group of 21 to 50 year thus it showed that dengue is more prevalent in young male population. Conclusion: The problem of dengue is ginormous in our country; the problem is multiplied due to humongous population, poor hygiene, lack of medical and diagnostic facilities, inadequate vector control measures, and lack of awareness among the population. Hence, future studies should be aimed to identify various atypical manifestations as well as early treatment protocols for timely intervention so as to halt the disease progression.

Major Neural Tube Defects With Facial Dismorphism- A Case Report

Neural tube defects [NTDs] are the disorders caused due to non closure of neural tube during 3rd to 4th week of embryonic period. NTDs have an incidence of 1-2 per 1000 births. Major types of NTDs include anencephaly, spinabifida, craniorachischisis, encephalocele, inencephaly. Present study was carried out to study craniorachischisis and associated malformations. Method: study was carried out on 24 weeks aborted female fetus showing gross neural tube defect, in department of anatomy. Result: fetus was having craniorachischisis i.e. complete failure of neurulation along with facial dismorphism and other malformations.

Environmental & lifestyle factors in deterioration of male reproductive health.

Background & objectives: Male reproductive function in the general population has been receiving attention in recent years due to reports of various reproductive and developmental defects, which might be associated with various lifestyle and environmental factors. This study was carried out to determine the role of various lifestyle and environmental factors in male reproduction and their possible association with declining semen quality, increased oxidative stress as well as sperm DNA damage. Methods: Semen samples were obtained from 240 male partners of the couples consulting for infertility problem. Semen analysis was carried out using WHO criteria and subjects were categorized on the basis of self reported history of lifestyle as well as environmental exposure. The oxidative and antioxidant markers; lipid peroxidation (LPO), superoxide dismutase (SOD) and catalase (CAT) as well as DNA damage by acridine orange test (AO) were determined. Results: The presence of abnormal semen parameters was significantly higher among the lifestyle and/or environmental exposed subjects as compared to the non-exposed population. Further, the levels of antioxidants were reduced and sperm DNA damage was more among the lifestyle and/or environmental exposed subjects, though the changes were not significant. Interpretation & conclusions: These findings indicated that various lifestyle factors such as tobacco smoking, chewing and alcohol use as well as exposure to toxic agents might be attributed to the risk of declining semen quality and increase in oxidative stress and sperm DNA damage.

Feasibility and Validity of a Computer-based Version of SEIQoL-DW Compared to Original Interview-based Versions in Healthy Medical Students / General Medicine

<b>Purpose:</b> The Schedule for the Evaluation of Individual Quality of Life - Direct Weighting (SEIQoL-DW) is designed to investigate an individual's perspective on their own quality of life (QOL) and has been used widely among various clinical populations, including cancer patients and those with chronic kidney disease, in addition to healthy participants. While the original SEIQoL-DW is a semi-structured interview, other formats have been developed; recently computer-based versions have yielded equivalent results comparable to paper-based versions. However, no previous study has examined differences between the computer-based version and its original interview-based design. The purpose of this study is to assess the feasibility and validity of a computer-based version of the SEIQoL-DW, compared with the original interview-based format.<br><b>Methods:</b> We conducted a non-randomized crossover study with 13 medical students from November 2008 to January 2009 at a municipal university in Yokohama, Japan. Both the computer-based and interview-based versions of SEIQoL-DW were administered to all study participants. Wilcoxon-signed rank test was used to compare differences in mean SEIQoL Index score between computer-based and interview-based results. The intra-class correlation coefficient and the Bland and Altman limits of agreement methods were used to compare formats.<br><b>Results:</b> No significant differences were found in the SEIQoL-DW Index between the computer-based and interview versions after analysis with Wilcoxon-signed rank test (p = 0.501). The intra-class correlation between formats was 0.94 (CI: 0.81–0.98). The limit of agreement analysis showed that 53.3% of the observations were within ±1–5 units of the average score, while 46.7% were within ±5–10 units. In total, 100% of observations were within ±1–10 units.<br><b>Conclusions:</b> The computer-administered version of SEIQoL-DW may be feasible and acceptable and provides a valid alternative, at least in healthy subjects, to the more cumbersome interview version. Use of the computer-based version will facilitate its application to larger patient populations in various clinical settings.

Accidental intestinal myiasis caused by genus Sarcophaga.

Myiasis of different organs has been reported off and on from various regions in the world. We report a human case of intestinal myiasis caused by larvae of Sarcophaga. A 25 - year - old male presented with symptom of passage of live worms in stool. Following diagnosis and treatment the patient improved completely with cessation of maggots in stool.

Demonstration of sperm head shape abnormality and clastogenic potential of cypermethrin.

Adult male Swiss albino mice were administered ip. suspension solution of cypermethrin in 0.15% DMSO at the doses of 30 mg, 60 mg and 90 mg/kg b. wt. daily for 5 days. Another group of animals was injected cyclophosphamide ip. (60 mg/kg b. wt.) in similar manner which served as positive control. Effect of cypermethrin on body and testes weight and sperm head morphology was studied. Clastogenic potential of cypermethrin was studied by using modified Allium test. The cytological changes were studied in the root tip cells of Allium cepa after 3 days treatment with three different concentration of cypermethrin (0.1, 1.0 and 10.0 microg/ml). The results revealed that body weight gain was considerably reduced in higher dose groups, but the testicular weight did not change significantly in any of the cypermethrin treated groups. However, a significant elevation in the number of abnormal shape of sperm head was noticed in higher dose groups as compared to control. It was observed that the abnormality in the shape of sperm head was dose-dependent. The cytological changes in the root tip cells of Allium cepa indicated that cypermethrin is having toxic effects on the root tip cells in the form of stickiness of chromosomes and also affect the mitotic activity. This study suggest that cypermethrin may have the potential to induce adverse effects on sperm head shape morphology of mouse as well as clastogenic effects on root tip cells of Allium cepa.

Lead induced spermatoxicity in mouse and MPG treatment.

Protective efficacy of MPG (2-mercaptopropionyl glycine) was studied against the toxic effects of lead acetate in Swiss albino mice. The animals were treated with single dose of lead acetate @ 180, 200 and 250 mg/kg b.wt. in presence and absence of MPG. The results indicated that the body weight was slightly higher in MPG treated groups on day 10 as compared to only respective lead treated groups in all the three dose level. However, significantly lower body weight was observed in both lead treated and lead along with MPG treated groups as compared to control. Patten of mortality is similar in both lead treated and lead plus MPG treated groups. Conspicuous degenerative changes in testicular tissues and elevation in sperm head shape abnormality were observed in both lead treated and lead along with MPG treated groups but the sperm head shape abnormality and damage were more in lead treated groups as compared to lead plus MPG treated groups. But this difference was non-significant between the two groups. These observations suggest that MPG may not be significantly effective against lead induced damage in testicular tissues at cellular level. However, MPG is able to maintain slightly lower level of sperm abnormality in all the three dose level as compared to their respective lead treated groups. Further, studies are needed to find out the optimum dose of MPG for protection against the lower doses of lead induced lethality as MPG is not significantly effective against the higher doses of lead.

Double gall bladder with two disease processes.

A double gall bladder is a rare congenital anomaly which is usually diagnosed by preoperative ultrasonography. Either one, or both lobes, of the double gall bladder, may be diseased. We report a patient in whom the two lobes were affected by different disease processes, namely, cholesterosis, and cholelithiasis with mucocele.

Obstructive jaundice due to Fasciola hepatica.

A middle aged woman presented with obstructive jaundice of 6 months duration. Radiological investigations revealed multiple pyogenic liver abscesses with the possibility of choledocholithiasis. Exploration of common bile duct revealed that Fasciola hepatica was responsible for the illness. The case is reported because of its rarity.

Gallstone obstruction of the duodenum (Bouveret's syndrome).

Bouveret's syndrome is a rare complication of gallstones, leading to duodenal obstruction. We report a 25-year-old woman with this condition, probably the youngest patient reported.

An epidemiological study of G-6-PD deficiency, sickle cell haemoglobin, and ABO blood groups in relation to malaria incidence in Muslim and Christian communities of Kheda, Gujarat, (India).

783 blood samples for the study of distribution of ABO blood groups and sickle cell haemoglobin in relation to malaria, from both the sexes of Muslim and Christian populations of Kheda district were screened. 414 blood samples from male individuals were screened for G-6-PD deficiency. High frequency of G-6-PD deficiency was observed in Christians (5.9%) and low in Muslim (1.8%) population, whereas sickle cell haemoglobin in Muslim population was 1.5% and absent in Christians. Blood group B was dominant in both the communities. Significant association of ABO polymorphs with P. falciparum and total malaria cases was observed.

Sensitivity of mosquito-pathogenic bacterial strains to various antibodies.

Four strains of Bacillus sphaericus, 1593, 2362, 9001 and 9002, B. thuringiensis H-14 and B. thuringiensis neoleonensis were tested for sensitivity against 18 antibiotics. The results revealed that all the four strains of B. sphaericus are resistant to colistin, nalidixic acid, polymyxin B and streptomycin. However, B. thuringiensis H-14 was resistant to 9 antibiotics, viz. ampicillin, cephalexin, carbenicillin, co-trimoxazole, colistin, cloxacillin, penicillin, nitrofurantoin and polymyxin B whereas B. thuringiensis neoleonensis was found to be resistant to 8 antibiotics. These results may help in isolation of potential and resistant mosquito pathogenic bacteria.