Association of fibrinogen, fibrin degradation product, and D-dimer level with disease severity in hospitalized COVID-19 patients – A cross-sectional study in Eastern India

Background: Although most of the COVID-19 patients presented with mild symptoms and recovered, a considerable number of cases became serious with poor prognosis in an unpredictable manner. They mostly presented with respiratory symptoms and coagulation abnormalities with thrombosis and multi-organ failure. Hence, timely prediction of these cases with the early intervention might decrease mortality. Aims and Objectives: The objectives of this were to determine whether values of fibrinogen, fibrin degradation products (FDP), and D-dimer level correlates with disease severity in COVID-19 patients. Materials and Methods: This observational cross-sectional study was done on total 400 hospitalized COVID-19 adult patients where patients were categorized into moderate and severe cases as per guideline of Government of India. Patients with pre-existing coagulation disorder or receiving anticoagulant drugs were excluded from the study. FDP, fibrinogen, and D-dimer values of these two groups were evaluated and compared statistically to determine their significance. Results: Overall mean and standard deviation of fibrinogen, FDP, and D-dimer were 607.48 ± 177.73, 34.93 ± 29.2, and 6.23 ± 6.48 for severe category, while for moderate category disease, they were 389.77 ± 110.16, 10.79 ± 10.47, and 1.96 ± 3.3, respectively. Unpaired t-test showed that the study parameters are significantly higher in severe COVID-19 patients compared to moderate ones. Conclusion: It was concluded that elevated level of D-dimer, fibrinogen, and FDP is indicator of disease progression in COVID-19. Thus, regular estimation of these simple coagulation parameters may predict disease severity and help in adequate management.

Smartphone addiction among undergraduate medical students and its association with academic performance

Background and aims: Smartphones have become an indelible part of a student’s life; but, their effect on academic performance of medical students is unclear with sparse data. The objective of the study was to estimate the prevalence of smartphone addiction among undergraduate medical students, pattern of its use, and the association of smartphone addiction with academic performance. Method: We conducted a cross-sectional study on all the undergraduate medical students in the Medical College Baroda, Anandpura, Vadodara, Gujarat, India, from second year to internship after getting written informed consent. Sociodemographic details, patterns of smartphone use, and scores of the final examination appeared for, were obtained to assess academic performance using a self-report semi-structured questionnaire. Smartphone addiction was diagnosed using the Smartphone Addiction Inventory (SPAI). Result: Out of the 523 students approached, 427 returned completed questionnaires. Ninety five students (22.2%) had smartphone addiction, with the addicted students being more likely to change their phone often, use it for longer periods and in restricted places. No association was found with gender, age, years of use, and academic performance. Conclusion: Nearly one-fifth of the medical undergraduate students were suffering from smartphone addiction. However, it does not seem to have an association with academic performance among undergraduate medical students.

Comparison of risk profile in pre-menopausal and post-menopausal women with acute coronary syndrome

Background: The physiological changes associated with menopause are responsible for increase in cardiovascular disease after menopause. BMI, physical inactivity, metabolic syndrome, hypertension and diabetes mellitus increase in post-menopausal women which are all powerful predictors of cardiovascular events. The risk factor profile between pre-menopausal and post-menopausal women presenting with acute coronary syndrome was thus studied.Methods: This study was a prospective cross-sectional hospital based study and was conducted in the Department of Medicine and Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana wherein 50 pre-menopausal women and 50 post- menopausal women who presented with acute coronary syndrome were enrolled. The risk factor profile and angiography findings amongst the 2 groups were compared.Results: There was no difference in the incidence of Diabetes Mellitus and Hypertension among the pre & post-menopausal groups. The prevalence of family history of cardiovascular disease was higher in the pre-menopausal group. The post-menopausal women showed a significant decrease in physical activity due to sedentary lifestyle. Both the groups had high BMI and increased waist circumference. Lipid parameters did not show any significant difference between the two groups. However, pre-menopausal women had higher LDL-C and triglyceride levels and lower HDL-C levels. On analysis of the angiographic findings in diabetics and non-diabetics, of both the groups diabetes mellitus was much higher in subjects presenting with triple vessel disease suggesting extensive atherosclerosis.Conclusions: study showed physical inactivity as an important cardiovascular risk factor in post-menopausal women. Obesity is an important risk factor for coronary artery disease in both pre- and post-menopausal women.

High-intensity exercise-induced oxidative stress in sedentary pre-pubertal & post-pubertal boys: A comparative study

Background & objectives: High-intensity exercise results in oxidative stress in adult population. Impact of pubertal attainment on high-intensity exercise-induced oxidative stress in sedentary paediatric population has not been investigated in detail. The present study was conducted to investigate the extent of high-intensity exercise-induced oxidative stress in sedentary pre- and post-pubertal boys through estimation of serum thiobarbituric acid reactive substances (TBARS), total thiol content and activities of superoxide dismutase (SOD) and catalase (CAT). Methods: Sixty four sedentary pre-pubertal (n=32, age = 10.21�67 yr) and post-pubertal (n=32, age = 15.58�47 yr) boys performed incremental treadmill running exercise at 80 per cent of the age predicted maximum heart rate till volitional exhaustion. Blood sample (5 ml) was drawn from each individual before and after the exercise for estimation of oxidative stress markers. Results: Pre-exercise SOD activity and total thiol level showed significant positive relationship with age and were significantly higher in post-pubertal boys. Serum TBARS level, SOD and CAT activities increased while total thiol content decreased in both the groups following exercise. Post-exercise percentage change in TBARS, SOD activity and total thiol level was significantly higher in post-pubertal boys, and these variables had significant positive relationship with age. No significant intergroup variations were noted in CAT activity before or after exercise. Interpretation & conclusions: Extent of post-exercise oxidative stress increased significantly with attainment of puberty. However, baseline and post-exercise antioxidation status also increased significantly as a function of age with pubertal maturation allowing the post-pubertal boys to counter relatively higher oxidative stress more efficiently than their pre-pubertal counterparts. Post-exercise upregulation in CAT activity might not be influenced by age or pubertal maturation in this age group.

Pattern of cognitive deficits in vascular dementia

Background & objectives: There is a paucity of literature on the cognitive profiles of vascular dementia (VaD) in India. The current study was undertaken to investigate the pattern of cognitive deficits in patients with VaD. Methods: Fifty patients fulfilling the Diagnostic and Statistical Manual of Mental Disorders-IV criteria of dementia and National Institute of Neurological Disorders and Stroke - Association Internationale pour la Recherche et l'Enseignement en Neurosciences criteria for VaD were assessed using Mini Mental State Examination, Kolkata Cognitive Screening Battery and other relevant tests including magnetic resonance imaging of brain. Results: Twenty patients had small vessel dementia, whereas the least common was haemorrhagic dementia in four patients. In patients with small vessel dementia, apart from memory, all patients had problem in attention and executive function, whereas 12 patients had visuoconstructional deficit and eight patients had language problem. In a total of 12 patients with large vessel dementia, apart from memory, executive dysfunction and visuoconstructional deficit were noted in 10 patients, whereas attention deficit was noted in eight patients. Attention was found to be more involved in small-vessel dementia than large-vessel dementia though all had memory impairment (P<0.01). Interpretation & conclusions: Small vessel dementia was the commonest subtype of VaD in our study. Memory, attention and executive functions were predominantly affected in patients with VaD. Attention was significantly more involved in small vessel dementia than large vessel dementia. Further studies with large sample size need to be done in different regions of the country.

A morphometric study of adult human trachea in West Bengal population

Background: Keeping in view the great variations in different dimensions of the human trachea and its remarkable clinical importance, the present work was undertaken. It included the study of dimensions of adult trachea of both sexes in West Bengal population. In addition, an effort was made to establish their relationship with selected external measurements. Methods: This was a cross-sectional, observational study on 60 cadavers. Relatively disease-free fresh adult cadavers were selected from West Bengal population. Study variables were tracheal length, internal transverse diameter and internal anteroposterior diameter. Selected external measurements were height and sternal length. Results: In males, the highest correlation was observed between tracheal length and height (r = 0.800), and tracheal length and sternal length (r = 0.799). In females, the highest correlation coefficient was found between tracheal length and height (r = 0.809). Conclusion: Different formulae were obtained by linear regression with all measurements being in centimeters. Therefore, it is possible to predict the tracheal dimensions from simple external measurements.

Keratomycosis due to Purpureocillium lilacinum: A case report from Sub-Himalayan region of Uttarakhand

The fungus Purpureocillium lilacinum previously known as Paceliomyces lilacinus is an emerging pathogen that can cause severe human infections including devastating oculomycosis. Treatment with traditional antifungals often fails, and the organism shows variable susceptibility to novel triazoles. We hereby report a case of keratomycosis caused by Pur. lilacinum in an immunocompetent male patient following trauma. The patient was successfully treated with voriconazole. The drug shows good activity against Pur. lilacinum and could be a promising therapeutic alternative to treat infections caused by this fungus, which generally shows resistance to conventional antifungal agents including novel triazoles.

An outbreak of hepatitis A virus among children in a flood rescue camp: A post‑disaster catastrophe.

We report an outbreak of acute viral hepatitis among children in a flood rescue camp at Rudraprayag district of Uttarakhand State, India. In May 2013, there was a disastrous natural calamity, The Himalayan Tsunami in Himalayan and Sub‑Himalayan region of Uttarakhand. More than 5700 people were feared dead, and thousands were sheltered in different rescue camps. A linkage was hypothesised between the infected individuals and the common water sources feared of being contaminated faecally. Aetiological agent of the present outbreak was HAV that is emerging in an outbreak form in India, emphasizing a definite need for formulating mandatory vaccination and proper control strategies. The report exemplifies the basic problems encountered after a natural calamity.

articleClinico-pathological study of 273 cases of rhinosporidiosis over a period of ten years in a tertiary care institute catering predominantly rural population of tribal origin.

Introduction: Rhinosporidiosis is a chronic granulomatous infection caused by Rhinosporidium seeberi, an organism whose taxonomy is still debated. The present study was aimed to document the clinico-pathological presentation of rhinosporidiosis in different parts in reference to caste, age and gender. Evaluation of diagnostic role of cytology in the diagnosis of rhinosporidiosis was also explored. Materials and Methods: All histology confirmed rhinosporidial cases were included in the study. Detailed clinical history and examination findings including previous hematological and cytological reports, if available, were collected and tabulated. Periodic Acid Schiff (PAS) and Mucicarmine stains were used over cyto- and histological slides, if necessary. Observations: Male cases were more frequent in these series though this sex difference is less pronounced among tribal population. Majority of the cases belonged to 21-40 years age group. Nose and nasopharynx was the commonest site of infection and polypoid mass lesions were the commonest presentation. Both scrape and aspiration cytology could successfully detect rhinosporidiosis in 100% cases. Discussion: Most of the cases are among poor-socioeconomic status and probably out-door activities and pond bathing habit. Haematological data correlation did not revealed any significant association. Histology is the preferred method for confirmed diagnosis of rhinosporidiosis. Rare cases of misdiagnosis can be avoided by use of special stains. Conclusion: Rhinosporidiosis commonly presents as polypoidal lesions in nose and extra-nasal sites. Histopathology is the standard method for confirmation of diagnosis. Cytology can be used as an adjunct for pre-operative diagnosis of extra-nasal rhinosporidiosis. We recommended use of special stains for diagnosis of difficult cases

Quality of life after oesophagectomy in patients with carcinoma of oesophagus: A prospective study.

Background: The present study was done to see if quality of life improves following oesophagectomy for carcinoma of oesophagus. Materials and Methods: This was a prospective study done from June 2007 to July 2009. All patients undergoing oesophagectomy and cervical anastomoses for squamous cell carcinoma and adenocarcinoma of oesophagus were included in the study. Quality of life assessment was done using EORTC QLQ C-30 and its oesophagus specific module (OES-18) before surgery and at 3, 6, 9 and 12 months. Results: There were 55 patients who underwent oesophagectomy for carcinoma of oesophagus. On the EORTC functional scale it was noted that patients undergoing transhiatal oesophagectomy showed significant improvement of emotional function only. Patients undergoing transthoracic oesophagectomy showed a decrease in functional scores in the first three months which improved later but this change was not significant. On the EORTC symptom scale, patients undergoing transhiatal oesophagectomy showed significant improvement of constipation but not in other symptoms. Patients undergoing transthoracic oesophagectomy showed an increase in symptoms for the first three months followed by a decrease which was significant with respect to scores for constipation and pain. On the EORTC oesophagus specific symptom scores, patients in both groups showed significant improvement of dysphagia and eating. Conclusion: Patients with carcinoma of oesophagus undergoing transhiatal oesophagectomy may not show significant improvement in quality of life. However there will be significant improvement in dysphagia and eating. Patients undergoing transthoracic oesophagectomy may show an initial decrease in the quality of life.

Collision tumor of ovary: a rare combination of dysgerminoma and serous cystadenocarcinoma.

Collision tumors of ovary are rare neoplasms and most commonly consist of a teratoma with mucinous tumor. Combination of papillary serous cystsdenocarcinoma and dysgerminoma was yet to be reported. A twenty years female patient presented with a large tumor of right ovary. Microscopically it was diagnosed as a collision tumor of ovary composed of dysgerminoma and serous cystadenocarcinoma. Mixed tumour can arise from divergent differentiation of a single type of stem cell. But components of collision tumor must arise from separate clones. Possibility of collision tumour should always kept in mind during assessment of difficult ovarian tumors to avoid diagnostic error. Key words: Collision tumor, dysgerminoma and serous cystadenocarcinoma.

Animal Biotechnology Options in Improving Livestock Production in the Horn of Africa.

The techniques of modern biology incorporates molecular cloning of genes, gene transfer, genetic manipulation of animal embryo transfer, genetic manipulation of rumen microbes, chemical and biological treatment of low quality animal feeds for improved nutritive value, genetically engineered immunodiagnostic and immunoprophylactic agents as well as veterinary vaccines, inter alia. Of course, these are a reality today and are finding their ways into research and development programs of developing countries. Biotechnology is offering unprecedented opportunities for increasing agricultural productivity and for protecting the environment through reduced use of agro-chemicals. The major thrust in biotechnology research is currently directed at solving immediate problems of industrialized countries, with major investments coming from transnational companies. However, many of the new discoveries and products will find their biggest markets in developing countries where the potential for improvement in agricultural productivity and health is greatest. The importance of biotechnology and its relevance is only slowly being accepted by policy makers in developing countries. In the presence of economic crisis, strong fiscal constraints, rapid social change and constant political instabilities, the difficulties associ ated with major policy changes in developing countries are enormous. In this review we discuss the potentials and limitations for biotechnological applications in animal breeding and animal health, food processing and forage improvement in the horn of Africa.

Anthropometric Status between Tribal and Non Tribal School Children.

A descriptive cross sectional study named "Anthropometric status between tribal and non tribal school children" was conducted on Guimara primary school, Matiranga, Kharagrachari and Thana primary school, Sitakund, Chittagong to assess the difference in nutritional status between tribal and non tribal school children aged 6 to 10 years in terms of selected indicators. The indicators were height for age Z score, weight for height Z score, and weight for age Z score. Data were collected by interview from mother of the child through semi-structured questionnaire and measuring height and weight of 128 children. Among them 63 were selected from tribal community and 65 from non tribal area. The study revealed that 9.2% non tribal and 7.9% tribal children were severely stunted, 12.3% non tribal and 1.6% tribal were moderately wasted and 9.2% non tribal and 1.6% tribal children were moderately underweight. In relation to sex among tribal children 12.9% tribal boys and 3.1% tribal girls were severely stunted, only 3.2% tribal boys were both moderately wasted and underweight. In case of non tribal children 17.9% boys and 2.7% girls were severely stunted, 17.9% boys and 8.1% girls were moderately wasted and 17.9% boys and 2.7% girls were moderately underweight. According to the age group of 6 to 7 years it was found that, only 4.2% non tribal children were severely stunted and 29.2% were moderately stunted where as 12% tribal children were moderately stunted. In both case of moderately wasting and underweight non tribal were 8.5% more than tribal children and among 8 to 10 years age group it was 12.2% and 7.3% more respectively and in case of severely stunted tribal children were 1% more than non tribal. Improper dietary practice was also found among the two group of study population. Information and health education should be provided to the parents of the children by community participation regarding proper use of sanitary latrine, provision of safe drinking water and proper dietary practice.

Cervical Intramedullary Ancient Schwannoma

A young male of 24 years was presented with a history of gradually progressive spastic quadriparesis for long four years. He was investigated and MRI revealed a neoplastic lesion in the cervical cord at the level of C4, C5 with perilesional edema and tumour syrinx formation, suggestive of astrocytoma. After total removal histopathology proved it to be an ancient schwannoma.

Antinociceptive activity of Sesbania sesban (Linn) wood extracts, a preliminary study.

The wood of the plant Sesbania sesban, is reported to have antinociceptive activity. To validate its folk use in the treatment of pain, wood was extracted successively with petroleum ether, chloroform, ethyl acetate, ethanol, and water to produce respective extracts. The extracts (50 and 100 mg/kg, ip) were screened for antinociceptive activity using hot plate test and acetic acid-induced writhing test in mice. Petroleum ether, chloroform, and ethyl acetate extracts showed significant and dose-dependent activity in both the tests. In order to find out the involvement of opioid receptors, effect of naloxone (1 mg/kg, sc) on the action of extracts was checked in hot plate test. Petroleum ether, chloroform, and ethyl acetate extracts showed significant and dose dependant antinociceptive activity. The antinociceptive action of the extracts was blocked by naloxone, suggesting involvement of opioid receptors in the action.

Pulmonary manifestations in systemic lupus erythematosus (SLE) with special reference to HR CT.

AIMS AND OBJECTIVES: 1. To evaluate whether CT helps in the early diagnosis of pulmonary manifestations in SLE. 2. To study the pulmonary involvement and determine the incidence and type of pulmonary involvement. MATERIALS AND METHODS: Thirty eight patients fulfilling ACR classification criteria for SLE were studied. Chest X-ray, pulmonary function tests (PFT), HRCT scan thorax were done. Investigations were done to detect other organ involvement. Patients with known interstitial lung disease (occupational hazard) or pregnant females were excluded. RESULTS: Clinical signs and symptoms referable to pulmonary involvement were present in 9 patients (23.68%). HRCT thorax detected abnormalities in 21 patients (55.26%); pulmonary function abnormalities were present in 11 patients (28.95%) and plain X-ray chest abnormalities were present in 7 patients (18.42%). Out of 38 patients pulmonary involvement was present in 22 (57.89%) cases and HRCT thorax findings were present in 21 (95.45%) of them. CONCLUSION: Pulmonary involvement is present in a significant number of SLE patients, who are often asymptomatic, with normal chest X-ray or normal PFT. HRCT scan thorax could diagnose the pulmonary involvement in asymptomatic patients with normal chest X-ray and uncertain PFT.