COVID-19: Time for a clinical classification?

COVID-19 pandemic caused by SARS-CoV-2 virus has been around for 2 years causing significant health-care catastrophes in most parts of the world. The understanding of COVID-19 continues to expand, with multiple newer developments such as the presence of asymptomatic cases, feco-oral transmission, and endothelial dysfunction. The existing classification was developed before this current understanding. With the availability of recent literature evidences, we have attempted a classification encompassing pathogenesis and clinical features for better understanding of the disease process. The pathogenesis of COVID-19 continues to evolve. The spiked protein of the SARS-CoV-2 virus binds to ACE2 receptors causes direct cytopathic damage and hyperinflammatory injury. In addition to alveolar cells, ACE2 is also distributed in gastrointestinal tract and vascular endothelium. ACE2–SARS-CoV-2 interaction engulfs the receptors leading to depletion. Accumulation of Ang2 via AT1 receptor (AT1R) binding causes upregulation of macrophage activity leading to pro-inflammatory cytokine release. Interleukin-6 (IL-6) has been attributed to cause hyperinflammatory syndrome in COVID-19. In addition, it also causes severe widespread endothelial injury through soluble IL-6 receptors. Thrombotic complications occur following the cleavage and activation of von Willebrand factor. Based on the above understanding, clinical features, organ involvement, risk stratification, and disease severity, we have classified COVID-19 patients into asymptomatic, pulmonary, GI, and systemic COVID-19 (S-COVID-19). Studies show that the infectivity and prognosis are different and distinct amongst these groups. Systemic-COVID-19 patients are more likely to be critically ill with multi-organ dysfunction and thrombo-embolic complications.

Intraocular lens-sling technique: A safe approach for lens implantation in complicated cataract surgery and secondary intraocular lens implantation

Among 20 million cataract surgeries being performed worldwide every year, approximately 5% are being complicated by posterior capsule rent or zonular dialysis. Intraocular lens (IOL) implantation in such cases with intraoperative complications is quite challenging. Our next course of action is to place the IOL in the ciliary sulcus, however, there is a risk of IOL drop into the vitreous in cases of inadequate support. We have described a novel idea of using a suture material through the dialling hole of a three-piece rigid IOL which can be used as a leash to reduce the risk of IOL drop during implantation in such cases. This technique could also be used during sutureless scleral fixated IOL and retro-pupillary iris claw lens implantation. We found that in 90 consecutive patients where this technique was used, there was no incidence of IOL drop or retinal detachment.

Chemopreventive potential of geraniol in 7,12-dimethylbenz(a) anthracene (DMBA) induced skin carcinogenesis in Swiss albino mice.

The present study investigated the chemopreventive potential of geraniol, an acyclic monoterpene alcohol, by monitoring the tumor incidence and analyzing the status of phase II detoxification agents, lipid peroxidation by products and antioxidants in 7,12-dimethylbenz(a)anthracene (DMBA) induced mouse skin carcinogenesis. Skin tumor was developed by painting DMBA (25 μg in 0.1 ml acetone mouse-1) in the shaved back of the mice, twice weekly for 8 weeks. We noticed 100% skin tumor formation in mice treated with DMBA alone. The status of phase II detoxification agents and antioxidants were decreased where as lipid peroxidation by products were increased in tumor bearing mice. Oral administration of geraniol at a dose of 250 mg kg-1 body weight significantly prevented the tumor formation as well as brought back the status of phase II detoxification agents, lipid peroxidation by products and antioxidants to near normal range in DMBA treated mice. Present results suggest that geraniol might have inhibited abnormal cell proliferation occurring in skin carcinogenesis by modulating the activities of phase II detoxification agents and through its free radical scavenging potential.

Anti-tumor activity of rosmarinic acid in 7,12-dimethylbenz(a)anthracene (DMBA) induced skin carcinogenesis in Swiss albino mice.

Aim of the present study was to evaluate the anti-tumor effect of orally administered rosmarinic acid in 7,12-dimethylbenz(a)anthracene (DMBA) induced skin carcinogenesis in Swiss albino mice. Phase I and II detoxication agents, lipid peroxidation byproducts, antioxidants and apoptotic biomarkers were used to assess chemopreventive efficacy of rosmarinic acid in DMBA induced skin carcinogenesis. Skin squamous cell carcinoma was induced at the shaved back of mice by applying DMBA (20 μg in 0.1 mL acetone) twice weekly for 8 weeks. Tumor formation (100%) was observed within 15 weeks of treatment in DMBA alone. Marked alterations in the status of above mentioned biomarkers were observed in tumor bearing mice. Oral administration of rosmarinic acid completely prevented the formation of skin tumors during DMBA-induced mouse skin carcinogenesis. Also, oral administration of rosmarinic acid brought back the status of phase I and phase II detoxication agents, lipid peroxidation byproducts, antioxidants and apoptotic markers (p53, Bcl-2, caspase-3 and caspase-9) in DMBA treated mice. Results of the present study suggested that rosmarinic acid had potent anti-cancer, anti-lipid peroxidative and apoptotic effect in DMBA-induced skin carcinogenesis.

Community health insurance schemes & patient satisfaction - evidence from India.

Background & objectives: Quality of care is an important determinant for utilizing health services. In India, the quality of care in most health services is poor. The government recognizes this and has been working on both supply and demand aspects. In particular, it is promoting community health insurance (CHI) schemes, so that patients can access quality services. This observational study was undertaken to measure the level of satisfaction among insured and uninsured patients in two CHI schemes in India. Methods: Patient satisfaction was measured, which is an outcome of good quality care. Two CHI schemes, Action for Community Organisation, Rehabilitation and Development (ACCORD) and Kadamalai Kalanjiam Vattara Sangam (KKVS), were chosen. Randomly selected, insured and uninsured households were interviewed. The household where a patient was admitted to a hospital was interviewed in depth about the health seeking behaviour, the cost of treatment and the satisfaction levels. Results: It was found that at both ACCORD and KKVS, there was no significant difference in the levels of satisfaction between the insured and uninsured patients. The main reasons for satisfaction were the availability of doctors and medicines and the recovery by the patient. Interpretation & conclusions: Our study showed that insured hospitalized patients did not have significantly higher levels of satisfaction compared to uninsured hospitalized patients. If CHI schemes want to improve the quality of care for their clients, so that they adhere to the scheme, the scheme managers need to negotiate actively for better quality of care with empanelled providers.

Protective effect of Withaferin-A on tumour formation in 7,12-dimethylbenz[a]anthracene induced oral carcinogenesis in hamsters.

With an aim to investigate the protective effect of Withaferin-A on 7,12-dimethylbenz[a]anthracene (DMBA) induced oral carcinogenesis in Syrian golden hamsters, tumour incidence, tumour volume and tumour burden and status of detoxication agents, lipid peroxidation and antioxidants in DMBA administered (3 times/week for 14 weeks) hamsters were assessed. Hundred percent tumour formation in DMBA alone administered animal was observed. Oral administration of Withaferin-A (20 mg/kg body weight) to DMBA administered animals for 14 weeks completely prevented the tumour incidence, tumour volume and tumour burden. Also, Withaferin-A showed significant anti-lipid peroxidative and antioxidant properties and maintained the status of phase-I and phase-II detoxication agents during DMBA-induced oral carcinogenesis. The results thus indicate that the protective effect of Withaferin-A is probably due to its anti-lipid peroxidative and antioxidant functions as well as modulating effect on carcinogen detoxication during DMBA-induced oral carcinogenesis.

Antihyperglycemic and antihyperlipidemic effects of Tephrosia purpurea leaf extract in streptozotocin induced diabetic rats.

Diabetes mellitus is a worldwide leading metabolic syndrome, associated with profound alterations in carbohydrate, lipids, lipoproteins and protein metabolisms. Worldwide, traditional practitioners for the treatment of diabetes and its complications use a wide variety of medicinal plants. In the present study the aqueous extract of Tephrosia purpurea leaves (TpALet) was evaluated for its antihyperglycemic and antihyperlipidemic effects in streptozotocin induced diabetic rats. Profound alterations in the concentrations of blood glucose, lipids and lipoproteins were observed in diabetic rats. Oral administration of TpALet to diabetic rats at a dose of 600 mg/kg body weight significantly reduced the level of blood glucose and increased the level of plasma insulin as well as normalized the lipids and lipoproteins profile. The present study thus demonstrated that TpALet has prominent antihyperglycemic and antihyperlipidemic effects in streptozotocin induced diabetic rats.

Antigenotoxic Effect of Ferulic Acid in 7;12-Dimethyl Beza (A) - Anthracene (DMBA) Induced Genotoxicity

The antigenotoxic effect of ferulic acid was carried out by evaluating the cytogenetic markers; the micronuclei frequency and chromosomal aberrations; in the bone marrow of hamsters in 7;12dimethylbenz(a)anthracene (DMBA) induced genotoxicity. Genotoxicity was induced in experimental hamsters by single intraperitoneal injection of DMBA (30mg kg-1 b.w). Pretreatment of ferulic acid orally at a dose of 40mg kg-1 b.w for five days significantly reduced the frequency of micronucleated polychromatic erythrocytes (MnPCEs) and the percentage of chromosomal aberrations in hamster's bone marrow. Our results thus suggest that ferulic acid has potent antigenotoxic effect in DMBA induced genotoxicity in golden Syrian hamsters

Lipid peroxidation & antioxidants status in patients with oral squamous cell carcinoma.

BACKGROUND & OBJECTIVE: Overproduction of lipid peroxidation byproducts and disturbances in antioxidant defense system have been implicated in the pathogenesis of several diseases including oral cancer. Though several studies have been done on the level of lipid peroxidation and antioxidants in oral cancer patients, there are no reports in patients with various clinical stages of oral squamous cell carcinoma. We carried out this study to assess the level of oxidative stress in oral cancer patients with various clinical stages. METHODS: Blood samples of 48 adult male oral cancer patients with various clinical stages of oral cancer (stage II to stage IV, 16 of each) and 16 age and sex matched healthy subjects were collected. Plasma and erythrocytes levels of thiobarbituric acid reactive substances (TBARS), vitamin E, reduced glutathione (GSH), and activities of superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) were assayed using specific colorimetric methods. The statistical comparisons were performed by one way analysis of variance (ANOVA) followed by Student's t-test. RESULTS: Elevated lipid peroxidation and decline in non-enzymatic and enzymatic antioxidants status were noticed in oral cancer patients as compared to healthy subjects. The TBARS levels were gradually increased whereas antioxidants were gradually reduced from stage II to stage IV of oral cancer patients. INTERPRETATION & CONCLUSION: The altered lipid peroxidation in plasma and erythrocytes of oral cancer patients may be related to their compensatory changes in the antioxidants defense system.

Role of life-style on plasma and erythrocyte membrane lipid profile in gastric cancer patients.

The present study has examined the role of life-style on plasma and erythrocyte membrane lipid profile in 25 adult male gastric cancer patients as well as age and sex-matched controls. Total, free and LDH cholesterol were markedly elevated in plasma and erythrocyte membrane whereas HDL cholesterol and triglycerides were significantly reduced in gastric cancer patients. These changes can be attributed to alcohol consumption and cigarette smoking-risk factors in gastric carcinogenesis, associated with low levels of ascorbic acid and vitamin E.

Clinical, haemodynamic and echocardiographic study in chronic cor pulmonale.

Thirty patients of chronic cor pulmonale were studied clinically and by chest skiagram, electrocardiography, echocardiography, pulmonary function tests, arterial blood gas analysis and, wherever possible by right heart catheterization. Pulmonary arterial pressures (PAP) correlated significantly only with cardiomegaly on skiagram and with arterial oxygen tension (PaO2). There was no significant correlation between mean PA pressures and prominent pulmonary conus on RVH by ECG, FEV1, PaCO2 or right ventricular outflow tract dimensions by echocardiography. Left ventricular function, as assessed by pulmonary capillary wedge pressure on cardiac catheterization, by LV ejection fraction and fractional shortening on echocardiography was normal in all cases except two (6.67%). There was significant increase in left ventricular posterior wall thickness in the patients studied.