Patients with Diabetes Experienced More Serious and Protracted Sickness from the COVID-19 Infection: A Prospective Study.

Background and Objectives: In December 2019, a flu-like illness began in the Chinese city of Wuhan. This sickness mainly affected the lungs, ranging from a minor respiratory tract infection to a severe lung involvement that mimicked the symptoms of Severe Acute Respiratory Syndrome (SARS). The World Health Organization (WHO) labelled this sickness as a pandemic in March 2020, after it quickly spread throughout the world population. It became clear, as the illness progressed, that people with concomitant illnesses, particularly diabetes mellitus (DM) and other immunocompromised states, were outmatched by this illness. This study was aimed to evaluate the correlation between Computed Tomographic Severity Score (CTSS) and underlying diabetes mellitus in coronavirus disease (COVID)-19 patients. Materials and Methods: This was a hospital-based prospective study in which a total of 152 patients with reverse transcriptase polymerase chain reaction (RT-PCR) positive COVID status who underwent high-resolution computed tomography (HRCT) of the chest were evaluated and categorized into mild, moderate and severe cases based on the extent of lung parenchymal involvement. A total score from 0-25 was given, based on the magnitude of lung involvement. Statistical analysis was used to derive a correlation between DM and CTSS, if any. Results: From our study, it was proven that patients with underlying diabetic status had more severe involvement of the lung as compared to non-diabetics, and it was found to be statistically significant (p = 0.024). Conclusions: On analysis of what we found based on the study, it can be concluded that patients with underlying diabetic status had a more prolonged and severe illness in comparison to non-diabetics, with higher CTSS in diabetics than in non-diabetics.

Predictors of Morbidity and Mortality in Organophosphorus Poisoning: A Case Study in Rural Hospital in Karnataka, India.

BACKGROUND: Organophosphorus (OP) pesticides poisoning can result from occupational, accidental or intentional exposure. Clinical manifestations include cholinergic syndromes, central nervous (CNS) system and cardiovascular disorders. Death is usually due to cardiovascular and respiratory failure. AIM: To evaluate various parameters that can predict outcome of patients in OP poisoning. MATERIALS AND METHODS: A prospective study conducted in Department of Medicine, Adichunchingiri Institute Of medical Sciences and Research Centre, Karnataka, over period of 1 year. Diagnosis of OP poisoning was based on clinical history of exposure to OP compound and low serum pseudocholinesterase levels. RESULTS: In the present study 133 patients were enrolled, out of which 98.5% were suicidal cases and only 1.5% had accidental exposure. Majority of cases were young male, with F/M ratio 1:3.2. Mortality rates were higher in younger people and in patients who required prolonged ventilator support. The mortality rate was directly proportional to amount of poison consumed, lag time, organ failure (Acute Renal Failure) and plasma pseudocholinesterase levels. Acute complications were frequently noted and were related to morbidity and mortality. No strict relationship was found between liver dysfunction, electrolyte disturbance and clinical outcome. CONCLUSION: This case study concluded that mortality is directly proportionate to the lag time, amount of OP substances consumed, clinical severity, pseudocholinesterase levels, Acute renal failure and duration of ventilatory support. This study highlights the importance of rapid diagnosis, and initiation of early and effective treatment, which may result in less number complications and also decreases the mortality rates.

Mucinous Cystic Neoplasms of Pancreas.

The purpose of this study was to investigate the actual management of mucinous cystic neoplasm (MCN) of the pancreas. A systematic review was performed in December 2009 by consulting PubMed MEDLINE for publications and matching the key words "pancreatic mucinous cystic neoplasm", "pancreatic mucinous cystic tumor", "pancreatic mucinous cystic mass", "pancreatic cyst" and "pancreatic cystic neoplasm" to identify English language articles describing the diagnosis and treatment of the MCN of the pancreas. In total, 16,322 references ranging from January 1969 to December 2009 were analyzed and 77 articles were identified. No articles published before 1996 were selected because MCNs were not previously considered to be a completely autonomous disease. Definition, epidemiology, anatomopathological findings, clinical presentation, preoperative evaluation, treatment and prognosis were reviewed. MCNs are pancreatic mucin-producing cysts with a distinctive ovarian-type stroma localized in the body-tail of the gland and occurring in middle-aged females. The majority of MCNs are slow growing and asymptomatic. The prevalence of invasive carcinoma varies between 6% and 55%. Preoperative diagnosis depends on a combination of clinical features, tumor markers, computed tomography (CT), magnetic resonance imaging, endoscopic ultrasound with cyst fluid analysis and positron emission tomography-CT. Surgery is indicated for all MCNs.

"Excess gooD can be Dangerous". A case series of iatrogenic symptomatic hypercalcemia due to hypervitaminosis D.

Vitamin D is increasingly recognized to have several beneficial effects. Its toxicity, causing hypercalcemia, is considered as extremely rare. We report case series of 15 patients (most of them being elderly subjects) with iatrogenic symptomatic hypercalcemia in whom toxicity occurred due to empirical excessive administration of vitamin D by oral and parenteral route.

Double osteomalacia.

A 35-year old woman presented, with chronic vague ill health, subacute symptoms of decreased appetite, increased thirst, excessive urination, and rib pains, and acute quadriparesis. On evaluation, she was found to have type 1 Renal tubular acidosis, pseudofractures of ribs and Hypovitaminosis D. Administration of oral solution containing potassium citrate and citric acid along with pharmacological doses of Vitamin D and supportive treatment improved her condition remarkably. This case report highlights interesting coexistence of two disorders, one very common (Hypovitaminosis D) and one rare (Distal Renal Tubular Acidosis dRTA), in same patient, producing same pathology (osteomalacia).