IMPACT OF DIABETES MELLITUS ON CLINICAL PROFILE AND OUTCOME OF COVID-19 PATIENTS IN A TERTIARY CARE HOSPITAL

Objective: A novel coronavirus infection (SARS-CoV-2) pneumonia (COVID-19) has been quickly spreading throughout China and the rest of the world since December 2019. Respiratory tract infections are frequently linked to diabetes mellitus (DM), a different risk factor. This study has reported the clinical presentation and therapeutic outcomes of COVID-19 with diabetes.Methods: From medical records and histories provided by 72 Covid-19-infected patients with diabetes admitted to the KMCH institute of health sciences and research, Coimbatore, data on demographics, clinical, laboratory, and radiological characteristics as well as treatment outcomes were collected using data collection forms. Real-time reverse transcription polymerase chain reaction (RT-PCR) assay of 2019-CoV RNA was used to screen patients with Covid-19.Results: 72 diabetes patients who tested positive for Covid-19 were admitted for this study. SPSS software version 26 was used to evaluate the data that had been collected. Clinical profiles and outcomes of patients with and without diabetes underwent descriptive analysis. Controlled diabetics had a mean plasma glucose of 112.22±11.41, while uncontrolled diabetics had a mean plasma glucose of 154.2±23.22. Fever was the most prevalent symptom in both managed and uncontrolled diabetes patients (94% and 100%), followed by sore throat (84% and 88%). In patients with uncontrolled diabetes compared to those with controlled diabetes, breathlessness is considerably higher (p<0.05). In the CORADS scoring, 11 of the 34 diabetics with uncontrolled blood sugar levels had CORADS 6 (32.35%), compared to just 2 of the 38 diabetics with regulated blood sugar levels (5.26%), which is considerably higher (p<0.01). In uncontrolled diabetics, the length of hospital stay is much longer (p<0.001). Compared to diabetics with controlled blood sugar, uncontrolled patients SPO2 dramatically dropped (p<0.001). Those with uncontrolled diabetes are more likely to be admitted to the ICU than patients with controlled diabetes (p<0.05). In uncontrolled diabetes compared to controlled patients, the severity was considerably higher (p<0.05). One person who had uncontrolled diabetes died, although no one who had controlled diabetes died.Conclusion: Covid 19, persons with uncontrolled diabetes appear to be more likely to sustain lung damage, necessitating admission to the ICU, an extended stay in the hospital, and oxygen assistance throughout the duration of the illness.

Comparative evaluation of chelating efficacy of nano-chitosan, pomegranate extract, and ethylenediaminetetraacetic acid on primary radicular dentin An in vitro study

Background: Irrigation is a crucial aspect of root canal treatment, and it is imperative to employ chelating agents to eliminate the smear layer during biomechanical preparation. They in turn react with mineral content of dentin, leading to decreased strength and increased susceptibility to fracture. Aims: This study aimed to assess and compare mineral loss and microhardness from primary root canal dentin following the usage of different irrigating solutions and determine the least detrimental irrigant among the tested solutions. Materials and Methods: Sixty-six primary anterior teeth were divided into three groups with 22 in each– Group I: 17% ethylenediaminetetraacetic acid (EDTA) Group II: 0.2% Nano chitosan Group III: Pomegranate extract. The decoronated teeth were split longitudinally. Half of it was directly subjected to Vickers test, and the other half was immersed in a magnetic stirrer bath containing test solution to record the mineral loss from solution. Postmicrohardness values were recorded on the specimen and compared with initial values. Statistical Analysis Used: Statistical analysis was done using SPSS software (Version 20, SPSS, IBM, Armonk, NY, U. S. A). Results: Descriptive statistics were calculated, and the groups were compared using analysis of variance test and post hoc Tukey test. Pomegranate extract showed least effect on mineral content and microhardness compared to 17% EDTA and 0.2% nano chitosan. P ≤ 0.05 was considered statistically significant. Conclusion: Pomegranate aril extract showed better results with selected parameters.

Value addition of corn husks through enzymatic production of xylooligosaccharides

ABSTRACT Corn husks are the major wastes of corn industries with meagre economic significance. The present study was planned for value addition of corn husk through extraction of xylan, followed by its enzymatic hydrolysis into xylooligosaccharides, a pentose based prebiotic. Compositional analysis of corn husks revealed neutral detergent fibre 68.87%, acid detergent fibre 31.48%, hemicelluloses 37.39%, cellulose 29.07% and crude protein 2.68%. Irrespective of the extraction conditions, sodium hydroxide was found to be more effective in maximizing the yield of xylan from corn husks than potassium hydroxide (84% vs. 66%). Application of xylanase over the xylan of corn husks resulted into production of xylooligosaccharides with different degree of polymerization namely, xylobiose and xylotriose in addition to xylose monomer. On the basis of response surface model analysis, the maximum yield of xylobiose (1.9 mg/ml) was achieved with the enzymatic hydrolysis conditions of pH 5.8, temperature 44°C, enzyme dose 5.7U/ml and hydrolysis time of 17.5h. Therefore, the corn husks could be used as raw material for xylan extraction vis a vis its translation into prebiotic xylooligosaccharides.

Subclinical Hypothyroidism in Children.

Need and purpose of review: Subclinical hypothyroidism is a biochemical diagnosis characterized by raised thyroid stimulating hormone and normal free T4, without clinical features of hypothyroidism. This review analyzes the current evidence to arrive at a consensus and algorithm to manage this condition. Methods: We searched Pubmed, Cochrane and Embase for articles published between 1990 to 2014, and identified 13 relevant articles dealing with pediatric subclinical hypothyroidism which were suitable to include in our review. Conclusions: Subclinical hypothyroidism is often a benign problem which requires expectant management with periodic monitoring of thyroid function tests and natural progression to overt hypothyroidism occur lot less frequently than expected. There is a paucity of robust randomized intervention studies, especially studies focusing on clinical outcomes. Thyroid replacement therapy is not justified in children with subclinical hypothyroidism when Thyroid stimulating hormone is <10 mIU/L. The main risk factors for progression to overt hypothyroidism are female sex, goiter, family history of thyroid disorder, strongly positive thyroid peroxidase antibodies and symptoms suggesting hypothyroidism. An algorithm for managing this condition is suggested.

Identification of mistakes and their correction by a small group discussion as a revision exercise at the end of a teaching module in biochemistry.

Background. Graduate medical students often get less opportunity for clarifying their doubts and to reinforce their concepts after lecture classes. The Medical Council of India (MCI) encourages group discussions among students. We evaluated the effect of identifying mistakes in a given set of wrong statements and their correction by a small group discussion by graduate medical students as a revision exercise. Methods. At the end of a module, a pre-test consisting of multiple-choice questions (MCQs) was conducted. Later, a set of incorrect statements related to the topic was given to the students and they were asked to identify the mistakes and correct them in a small group discussion. The effects on low, medium and high achievers were evaluated by a post-test and delayed post-tests with the same set of MCQs. Results. The mean post-test marks were significantly higher among all the three groups compared to the pre-test marks. The gain from the small group discussion was equal among low, medium and high achievers. The gain from the exercise was retained among low, medium and high achievers after 15 days. Conclusion. Identification of mistakes in statements and their correction by a small group discussion is an effective, but unconventional revision exercise in biochemistry.

Assessment of insulin resistance and lipid bound sialic acid in alcoholic liver disease.

Background: Even though alcoholic liver disease is common disease in India, there are only limited reports about insulin resistance and no reports about lipid bound sialic acid in these cases. The present study was designed to evaluate insulin resistance and lipid bound sialic acid levels in patients with alcoholic liver disease Materials and methods: 50 alcohol liver disease cases groups [Fatty liver (n=18), alcoholic hepatitis (n=19) and cirrhosis (n=13)] and 38 controls were enrolled in the study. Fasting insulin, lipid bound sialic acid and liver function test parameters were analyzed in both the groups Results: Insulin, homeostasis model of insulin resistance and lipid bound sialic acid were significantly increased in alcohol liver disease cases compared to controls. Both insulin and insulin resistance were higher in alcoholic hepatitis and cirrhosis group compared to fatty liver group and controls Conclusion: To conclude, the present study demonstrates increased insulin resistance and lipid bound sialic acid in patients with ALD.

Unusual Canal Morphology In Mandibular Second Molar - A Case Report.

A case of unusual root morphology is presented to demonstrate anatomic variations in mandibular second molars. The most common configuration of mandibular second molar is to have two roots with three root canals; however mandibular molars may have many different combinations. Endodontic therapy was performed in a mandibular second molar with three separate roots one located mesially and two distally. Radiographically all 3 root canals terminated with individual foramina. Three orifices or 3 independent canals were found in the three separate roots, indicating a rare anatomic configuration. Looking for additional roots, canals and unusual morphology is an important part of successful endodontics, as the knowledge of their existence occasionally enable clinicians to treat a case that otherwise might have ended in failure.

Electrocardiographic and echocardiographic changes in perinatal asphyxia.

OBJECTIVE: To study the usefulness of cardiac enzymes in evaluating myocardial damage in perinatal asphyxia. METHODS: Thirty term babies with perinatal asphyxia and without any congenital malformations were selected as cases. They were compared with thirty healthy term babies without asphyxia. Myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac enzymes i.e, troponin-T and CK-MB levels. RESULTS: Among the 30 cases 23 had evidence of myocardial involvement while one baby in the control group had ECG evidence compatible with cardiac involvement. Cardiac enzymes were significantly increased in babies with perinatal asphyxia. The mean level of C-troponin-T among cases and controls were 0.22+/-0.28 and 0.003+/-0.018 while CK-MB levels were 121+/-77.4 IU/L and 28.8 +/- 20.2 IU/L respectively. C-troponin-T had higher sensitivity and specificity compared to CK-MB levels. Moreover, C troponin-T levels correlated well with severity and outcome in babies with perinatal asphyxia. CONCLUSION: C-Tropopnin assay is useful in evaluating the severity of myocardial damage and outcome in perinatal asphyxia.

Cardiac enzyme levels in myocardial dysfunction in newborns with perinatal asphyxia.

OBJECTIVE: To study the usefulness of cardiac enzymes in evaluating myocardial damage in perinatal asphyxia. METHODS: Thirty term babies with perinatal asphyxia and without any congenital malformations were selected as cases. They were compared with thirty healthy term babies without asphyxia. Myocardial dysfunction was evaluated using clinical, electrocardiography, echocardiography and cardiac enzymes i.e, troponin-T and CK-MB levels. RESULTS: Among the 30 cases 23 had evidence of myocardial involvement while one baby in the control group had ECG evidence compatible with cardiac involvement. Cardiac enzymes were significantly increased in babies with perinatal asphyxia. The mean level of C-troponin-T among cases and controls were 0.22+/-0.28 and 0.003+/-0.018 while CK-MB levels were 121+/-77.4 IU/L and 28.8 +/- 20.2 IU/L respectively. C-troponin-T had higher sensitivity and specificity compared to CK-MB levels. Moreover, C troponin-T levels correlated well with severity and outcome in babies with perinatal asphyxia. CONCLUSION: C-Tropopnin assay is useful in evaluating the severity of myocardial damage and outcome in perinatal asphyxia.

Growth hormone in intra-uterine growth retarded newborns.

OBJECTIVE: To study growth hormone levels in IUGR and healthy controls and its association with birth weight and ponderal index. METHODS: We studied 50 Intra uterine growth retarded (IUGR) and 50 healthy newborns born at term by vaginal delivery in JIPMER, Pondicherry, India. Cord blood was collected at the time of delivery for measurement of growth hormone. RESULTS: When compared with healthy newborns, IUGR newborns had higher growth hormone levels (mean +/- SD, 23.5 +/- 15.6 vs 16.2 +/- 7.61 ngm/ml, P = 0.019). A negative correlation was identified between growth hormone levels and birth weight (r2 = - 0.22, P = 0.03) and ponderal index (r2 = - 0.36, P = 0.008). Correlation of growth hormone levels was much more confident with ponderal index than with birth weight. CONCLUSION: At birth IUGR infants display increased growth hormone levels which correlate with ponderal index much more confidently than with birth weight.

Serum pepsinogen I and II levels in various gastric disorders with special reference to their use as a screening test for carcinoma stomach.

INTRODUCTION: The role of serum pepsinogen in the diagnosis of gastric carcinoma is well established. Its role in other common upper alimentary disorders has not been widely studied. The aim of this study was to describe the effect of various gastric disorders on the levels of pepsinogen I, pepsinogen II and pepsinogen I/II ratio, with an emphasis on the diagnosis of carcinoma stomach in the South Indian population. METHODS: A total of 210 patients in seven groups, including one control group, were studied. The groups included patients with carcinoma stomach, Helicobacter pylori gastritis, peptic ulcer, portal hypertensive gastropathy, non-ulcer dyspepsia and erosive gastritis. Serum pepsinogen I, pepsinogen II and pepsinogen I/II ratio were estimated using an enzyme-linked immunosorbent assay technique. RESULTS: Patients with carcinoma of the stomach, when compared with controls, had a significantly lower pepsinogen I level (87.2 microg/L vs. 158.1 microg/L, p=0.0002) and pepsinogen I/II ratio (4.3 vs. 7.2, p = 0.0001). No significant change in pepsinogen levels occurred in the other groups. The cut-off levels of pepsinogen I (115.3 microg/L) and pepsinogen I/II ratio (6.2), determined by THE ROC curve, when applied in parallel provided a sensitivity of 97% and a negative predictive value of 91.4% for the diagnosis of carcinoma stomach. When the tests were applied in parallel, the likelihood ratio of a negative test was 0.06, indicating that individuals without carcinoma stomach were 16 times more likely to have a negative test than those with carcinoma. This fulfilled the essential prerequisites of an ideal screening test. CONCLUSION: Serum pepsinogen estimation is a useful diagnostic tool in the diagnosis of carcinoma stomach. The significance of serum pepsinogen level in portal hypertensive gastropathy, non-ulcer dyspepsia, peptic ulcer, Helicobacter pylori gastritis and erosive gastritis was not established.

Isolated intracranial Rosai Dorfman disease masquerading as meningioma: a case report.

Isolated intracranial Rosai Dorfman disease (sinus histiocytosis with massive lymphadenopathy) is rare. We present a 26-year-old male who presented with left focal motor seizures becoming secondarily generalized of one-year duration. Clinically and radiologically patient was diagnosed to have a right parietal convexity meningioma. However on histopathological examination a final diagnosis of intracranial Rosai Dorfman disease was rendered.

Association of lipid profile and body mass index (bmi) in hypertensive patients of Eastern Nepal.

Dyslipidemia is closely associated with hypertension. Out of different fractions of lipoprotein, definite association of elevated LDL-Cholesterol (LDLc) and other lipid parameters has been well observed in hypertensive patients. The present cross sectional study was undertaken at BP Koirala Institute of Health Sciences with the aim to find out association of different lipid parameters and Body Mass Index (BMI) among newly diagnosed hypertension without any medications in Eastern Nepal. 80 hypertensive patients fulfilling JNC-7 criteria and 80 healthy controls were enrolled in this study. Lipid parameters (TC, TG, LDLc, VLDLc, HDLc) were estimated by Enzymatic Colorimetric test. Quetlet's formula was used to calculate BMI. Results were analyzed with student's 't' test and Pearson correlation analysis. Mean age of patients and controls were 36.30 +/- 7.73 yrs & 32.13 +/- 7.21 yrs respectively. There was significant increase in different lipid parameters namely TC (170.18 22.53 vs 145.23 21.13,P<0.005), TG (146.60 53.87 vs 119.77 35.61, P<0.005), LDLc (100.71 23.74 vs 79.25 20.10,P<0.05) and VLDLc (29.32 1077 vs 23.92 7.12, P<0.05) in patients as compared to the healthy controls. However there was no any significant difference in HDLc value. Pearson correlation analysis shows positive correlation of BMI with all the four lipid parameters even though it was not statistically significant. Thus this study shows direct association of BMI, dyslipidemia in hypertensive patients of the Eastern Nepal.

Autosomal recessive type I lissencephaly.

Lissencephaly (LIS) is a brain malformation manifested by a smooth cerebral surface, thickened cortical mantle and microscopic evidence of incomplete neuronal migration, excluding polymicrogyria and other cortical dysplasias. It is important to consider LIS in the diagnosis of developmental delay as many patients may be diagnosed as cerebral palsy. It may have familial occurrence and can occur in sibs of same family often leading to a diagnostic problem. Several lissencephaly syndromes have been described. Here a familial syndrome of lissencephaly is reported. Autosomal recessive inheritance is suggested by recurrence in sibs within the same family, but germ cell mosaicism for a dominant mutation cannot be excluded.