Type 2 DM An Independent Risk Factor For Poor Outcome In Moderate To Severe COVID-19

Background:Diabetes Mellitus has been shown to be a risk factor for severe COVID-19 disease. Few studies asse ssed effect of diabetes on the outcome exclusively in moderate to severe COVID 19 disease. Objective: To compare the clinical characteristics and outcome of hospitalized moderate and severe COVID-19 disease among patients with and without diabetes. Material And Methods:This retrospective study was conducted at Parul Sevashram Hospital from 1stApril 2021-30thApril 2021. Data on demographic profile, clinical symptoms, laboratory findings, complications and clinical outcome was collected and compared between patients with and without diabetes.Result:Total 319 patients were included with mean age 54.81±11.72 years. 28.5% had diabetes. The most common symptoms were fever, cough and shortness of breath. As compared to patients without diabetes, these patients had significantly higher levels of leucocyte count, CRP, Ferritin, LDH and D-Dimer. They also had more complications like ARDS, secondary infection and stroke and higher need of respiratory support (92.3% vs. 69.7%, P < 0.001). We also observed significantly greater mortality in patients with diabetes compared to those without diabetes (29.7% vs. 13.6%; P = 0.0014). These findings held true even on comparingpatients with only diabetes as comorbidity to those without any comorbidity.Conclusion:The study confirms that diabetes is an independent risk factor for higher inflammatory markers, risk of complications and in hospital mortality during hospitalization with moderate to severe COVID 19. New strategies are needed for more aggressive management of COVID 19 cases with diabetes to improve prognosis in these cases.

Identifying Risk Factors For ICU Admission During The Second Wave Of COVID 19 In A Tertiary Care Centre In Western India

Background:The substantial morbidity and mortality seen during second wave of coronavirus disease 2019 (COVID-19) pandemic necessitated identifying demographic, clinical and laboratory markers to assist the clinicians in early recognition of severe disease. We aimed to identify new factors or confirm previously identified factors for risk of ICU (Intensive care unit) admission during the second wave of COVID-19 infection. Material And Methods:This retrospective, single-centre study was conducted from April 1 2021-May30 2021. Data on demographic profile, clinical symptoms, and laboratory findings on admission was collected and compared between ICU and non-ICU patients. Result:Total 440 patients were included. Among these, 184(41.8%) needed ICU admission. The mean agewas 52.75±14.46years. 283(64.3%) patients were males. The most common symptoms were fever (70.7%), cough (65.5%), and shortness of breath (54.1%). As seen in previous studies, mean age, leucocyte count, CRP, S. ferritin, LDH, D-Dimer and comorbidities like diabetes mellitus, COPD, obesity were found more commonly in ICU patients as compared to non-ICU patients. (P= 0.0107, 0.0447 and 0.0314 respectively for diabetes, COPD and obesity). Presence of more than one comorbidity was associated with greater ICU admission (ICU vs. Non-ICU: 92(50%) vs. 99 (38.7%), p=0.0234).Time from symptom onset to hospitalization was also significantly longer in ICU patients (7.5±1.05 days vs 4.0±1.26 days; p=0.004). Conclusion:The study confirms that COVID patients who need ICU admission have significantly higher mean age, leucocyte count, CRP, S. ferritin, LDH, D-Dimer and comorbidity. In addition, COVID patients in ICU had significantly lower s. albumin levels and late presentation to hospital.

Pharmacological basis of drug therapy of Alzheimer's disease.

Alzheimer's disease is a progressive neurodegenerative disorder primarily manifesting as a loss of memory. Senile plaques and neurofibrillary tangles are the major histopathological alteration in the brain of Alzheimer's disease patients. A considerable deficiency of cholinergic neurons is a consistent finding in Alzheimer's disease. Therefore, many therapeutic strategies to augment cerebral concentration of acetylcholine such as cholinergic precursors, cholinergic receptor agonists, cholinesterase inhibitors and acetylcholine release modulators have been evaluated in Alzheimer's disease. Although cholinesterase inhibitors such as tacrine and galanthamine offer modest clinical benefits, other cholinergic agents have proved to be of limited therapeutic value. Efforts to enhance monoaminergic neurotransmission have also been largely disappointing. Therefore, emphasis is not being put on the use of combination of two class of drugs. Moreover, use of therapeutic agents based on the putative pathogenic etiology of the disease such as excitotoxicity, amyloidosis, aluminium accumulation, inflammatory mechanisms and free radical production is being evaluated. Desferrioxamine, non-steroidal anti-inflammatory drugs, prednisone, dapsone, vitamin E and idebenone are some such agents that are currently under investigation for the preventive or palliative effect in Alzheimer's disease. Neurotrophic factors such as nerve growth factor, brain derived neurotrophic factor and epidermal growth factor have shown promising results in animal studies. However, novel methods for delivering these molecules into the brain required to be developed before launching their clinical trials in man.

Safety of copper T as contraceptive after caesarean section.

Copper T was inserted in 45 cases following caesarean section. Motivation was easier, acceptance was higher and follow-up was good in this group of patients. With proper selection and careful follow-up complications could be reduced to the minimum.