Efficacy of Various Treatment Modalities on Patientrelated Outcome in Hospitalized COVID-19 Patients –A Retrospective Study

Background: The outbreak of coronavirus disease 2019 (COVID-19) caused by novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in China, in December 2019, and was declared a pandemic by WHO on March 11, 2020. The treatment is evolving and is mostly supportive in nature. Material and methods: This was a single-center retrospective study that included confirmed COVID-19 cases treated at our institute (a tertiary care hospital in Jammu and Kashmir, India), between March 2020 and December 2020. Patients with age more than 18 years were included in the study. Results: On evaluating the effect of various drug therapies used in management of COVID-19 patients of all severity, use of remdesivir and famotidine was associated with significantly higher odds of survival. In subgroup of patients with severe disease, use of systemic steroids was associated with significantly higher odds of survival in addition to remdesivir and famotidine. In patients with severe COVID-19 illness, likelihood of survival was significantly higher in those who received combination of systemic steroids plus remdesivir compared to steroids and remdesivir alone. Conclusion: Steroids were effective in severe COVID-19 illness and the combination of steroids and remdesivir was more effective in severe illness. There is a need to undertake more large scale prospective randomized trials to determine the most effective drug therapies to treat the sick patients and prevent worsening of mild cases.

In silico analysis of the structural and functional implications of SLC19A1 R27H polymorphism

In view of the documented association of solute carrier family 19 member 1 (SLC19A1) G80A (R27H) polymorphism with the risk for different types of cancers and systemic lupus erythematosus (SLE), we have reanalysed the case–control study on breast cancer to ascertain the conditions in which this polymorphic variant exerts the risk of breast cancer. Association statistics have revealed that this polymorphism exerts the risk for breast cancer under the conditions of low folate intake, and in the absence of well-documented protective polymorphism in cytosolic serine hydroxymethyltransferase. To substantiate this observation, we have developed a homology model of SLC19A1 using glycerol-3-phosphate transporter (d1pw4a) as a template where 73% of the residues were modelled at 90% confidence while 162 residues were modelled ab initio. The wild and mutant proteins shared same topology in S3, S5, S6, S7, S11 and S12 transmembrane domains. The topology varied at S1 (28–43 residue vs 28–44 residue), S2 (66–87 residue vs 69–87 residue), S4 (117–140 residue vs 117–139 residue), S8 (305–325 residue vs 305–324 residue), S9 (336–356 residue vs 336–355residue), and S10 (361–386 residue vs 361–385 residue) transmembrane domains between wild versus mutant proteins. S2 domain is shortened by three amino acid residues in themutantwhile in other domains the difference corresponds to one amino acid residue. The 3DLigandSite analysis revealed that the metallic-ligand-binding sites at 273Trp, 277Asn, 379Leu, 439Phe and 442Leu are although unaffected, there is a loss of active sites corresponding to nonmetallic ligand binding. Tetrahydrofolate and methotrexate have lesseraffinity towards the mutant protein than the wild protein. To conclude, the R27H polymorphism affects the secondary and tertiary structures of SLC19A1 with the significant loss in ligand-binding sites.

Application of multiple linear regression and machine learning algorithms to elucidate the association of poor glycemic control and hyperhomocysteinemia with microalbuminuria

Microalbuminuria is an early biomarker of general vascular dysfunction and a predictor of risk for cardiovascular and renal diseases. It is also considered as a marker of insulin resistance in both diabetic and non-diabetic patients. The rationale of this study was to elucidate threshold values of fasting blood glucose (FBS) and glycosylated hemoglobin (HbA1c) that are associated with microalbuminuria. In the parallel association of microalbuminuria with hyperhomocysteinemia was investigated. Machine learning algorithm and multiple linear regression were applied to study the association of poor glycemic control on microalbuminuria and hyperhomocysteinemia. In non-diabetic subjects with FBS <102 mg/dL and HbA1c <6.3%; and in diabetic subjects with good glycemic control (FBS: 102-118 mg/dL; HbA1c: 6.3-7.0%), urinary microalbumin levels were <40µg/mg creatinine. Poor glycemic control (FBS >172 mg/dL and HbA1c >9.0%) was associated with microalbumin >40µg/mg creatinine. Age, gender, HbA1c and FBS were shown to explain variability in urinary microalbumin to the extent of 54.4% as shown by multiple linear regression model. Analysis of variance (ANOVA) revealed higher levels of FBS (F: 39.77, P <0.0001), HbA1c (F: 64.31, P <0.0001) and total plasma homocysteine (F: 3.69, P =0.04) in microalbuminuria and clinical microalbuminuria groups when compared to subjects with normal microalbumin levels. Diabetic patients with poor glycemic index had a more B12 deficiency. Poor glycemic index and hyperhomocysteinemia were associated with clinical microalbuminuria.

Quantitative and qualitative changes in human Meissner’s corpuscle at different ages: a light microscopic analysis.

Background: Meissner’s corpuscle is the most complex sensory receptors of the skin; providing information about rapidly fluctuating mechanical forces acting on the hairless skin. Aim of current study was to study density and structural changes in human Meissner’s corpuscles at different ages Methods: Samples were obtained from finger tips of fifteen persons and divided into three groups according to age: group A <15years; group B: 16-45 years and group C: 46-72 years. 5 μm thick sections were prepared, impregnated with silver and observed under compound light microscope. Density of Meissner’s corpuscles (Mcs) was studied by calculating Meissner’s Index (MI). Results: In group A, the MI was 0.86-0.90, which increased to 0.96 in group B and dropped in group C to 0.4 (in the seventh decade). The analysis of variance showed significant difference (P = 0.019) in MIs of the three age groups. The size of the Mcs was largest in group B, followed by group C and smallest in group A. The analysis of variance showed that there was highly significant difference (P = 0.003) between the size of Mcs in all the three age groups. It was observed that morphology of Mcs alter with age. In children these consisted of rudimentary coil of nerve fibers around collection of cells. In adults the intra-corpuscular nerve fibers were compressed into a tight spiral and modifications of nerve fibers, like end bulbs, varicosities and networks, were well developed. In old age Mcs were attenuated consisting of tangled mass of nerve fibers. Conclusion: It can be concluded that in adults the Mcs are greater in number, larger in size and complicated in structure, compared to young and old people.

Unusual foreign body insertion in rectum and vagina in schizophrenic patient.

Insertion of foreign body in to the body is rare in medical literature. Here we report a case of 21 year old female who presented to emergency with acute abdomen and on detailed evaluation turned out to be schizophrenia. Our patient had history of insertion of ball pen in rectum following command hallucination. The foreign body was later removed through laparotomy. The cause of insertion of foreign body are multiple from command hallucination, suicidal attempt, erotism to somatic delusions. Thus the clinician should always be vigilant while dealing with psychiatric patients as sometimes impacted foreign body can present as acute emergency.