A Comprehensive Analysis of Clinical, Biochemical, and Polysomnographic Characteristics in Patients With Type 2 Diabetes Mellitus With and Without Obstructive Sleep Apnea.

BACKGROUND: Obstructive sleep apnea (OSA) has been a significant contributor to mortality all across the globe. The most attributing factors to pathogenesis are metabolic syndrome, obesity, diabetes, and so on, but the indicators of its early detection are still elusive. OBJECTIVE: The study aimed to compare the clinical, biochemical, and polysomnographic characteristics of type 2 diabetes patients with and without OSA. DESIGN AND METHODS: This cross-sectional study was conducted at the Department of Medicine and Endocrinology Unit of Dayanand Medical College and Hospital, Ludhiana. A total of 584 patients with type 2 diabetes were assessed using the Berlin questionnaire, with 302 fulfilling the criteria for a high risk of OSA. Out of 302 patients who met the criteria for the high-risk category, 110 patients underwent a sleep study. RESULTS:  Three hundred and two patients satisfying the inclusion and exclusion criteria were enrolled in the study. A total of 110 patients underwent a sleep study, of which 68 (61.8%) had evidence of OSA. The waist-to-hip ratio was considerably higher in the OSA patients than in the non-OSA group (1.09 vs 0.930, p = 0.001). HbA1c >7% was found in 58.8% of OSA patients contrary to 38.1% of non-OSA patients. Fasting plasma glucose levels (>126 mg/dl) were identified in a substantially larger proportion of OSA patients than the non-OSA patients (64.7% vs 45.2%, p = 0.04). Similarly, peripheral neuropathy was found more commonly in the OSA patients than in the non-OSA patients (47% vs. 26.1%, p = 0.02). Prevalence of retinopathy, nephropathy, coronary artery disease, stroke, heart failure, and peripheral vascular disease did not differ significantly between the two groups. CONCLUSIONS: OSA frequently occurs among individuals diagnosed with type 2 diabetes mellitus. The prompt identification of OSA within this demographic is imperative to pinpoint those at an elevated risk of succumbing to conditions such as peripheral neuropathy, the exacerbation of glycemic control, and the onset of unmanaged hypertension. Moreover, there exists a positive correlation between the waist-to-hip ratio and the prevalence of OSA in persons with type 2 diabetes mellitus, highlighting the critical role of waist-to-hip ratio assessments in this patient population.

Role of Fine Needle Aspiration Cytology in the Rapid Diagnosis of Pulmonary Infections in Renal Allograft Recipients with Respiratory Failure.

Background: Renal transplantation is the treatment of choice in patients with end-stage renal disease. However, allograft recipients are at a higher risk of infection due to immunosuppressive therapies. This study aimed to analyze the utility of fine needle aspiration cytology (FNAC) lung in the etiological diagnosis of pulmonary infections in renal allograft recipients with respiratory failure. Materials and Methods: This is a retrospective study done in post-renal transplant patients presenting with pulmonary infections and respiratory failure in the past 7 years, in whom image-guided lung FNAC was done for diagnosis. Results: A total of 35 renal allograft recipients presenting with respiratory failure and having focal or diffuse pulmonary opacities (lesions) on radiological imaging were subjected to lung FNAC. The mean age of the patients was 41.1 ± 11.8 years (range 19-72), with the majority being males (n = 28, 80%); six (17.1%) of them were on invasive ventilation. The diagnostic yield of FNAC in our cohort was 77.1% (27 out of 35). Microorganisms were isolated in 21 cases (60%), with Nocardia being the most common (nine cases, 25.7%), Mycobacterial tuberculosis identified in six patients (17.1%), Aspergillus in three (8.6%), and one (2.9%) each had atypical Mycobacterium, zygomycetes, and Cryptococcus. FNAC suggested viral cytopathic effect in five patients, and cytomegalovirus (CMV) quantitative polymerase chain reaction test was found positive in four of these. One case was diagnosed as adenocarcinoma lung. Conclusion: Lung FNAC is a useful for establishing the etiological diagnosis of pulmonary lesions in renal transplant patients with respiratory failure.

Behaviour and Microstructural Characteristics of Lime-GGBS-Treated Kaolin Clay Contaminated with Gypsum.

In this experimental study, the physico-mechanical and microstructural properties of sulphate-bearing clays have been investigated. Sulphate bearing soils constituted by mixing kaolin and gypsum at 0%, 15%, 25%, and 35% gypsum contents were treated with 12% ordinary Portland cement (OPC) and 4%Lime (L) and 8% ground granulated blast furnace slag (GGBS) and subjected to compaction, swell, unconfined compressive strength (UCS), California bearing ratio (CBR), and scanning electron microscopy (SEM) and energy dispersive spectrometry (EDX) analyses. The results of the study showed that the use of L-GGBS improved the soaked CBRs of the treated samples by over 43% when compared to OPC-treated samples after 7-days curing. A reduction in water absorption by 82% was also observed with L-GGBS treatment after 28-days curing. The UCS results also showed better performance with L-GGBS treatment exceeding 856% at 28 days. The effect of increased cementitious product with increasing gypsum content was negated by simultaneous and rapid growth of ettringite minerals which reduced the strength and increased swelling of OPC treated samples up to 18.92%, exceeding allowable limits of 2.5% as specified in Highway Agency Advice Note HA 74/07. The L-GGBS treated gypseous soil samples meet the strength requirement for stabilised sub-base (CS) and stabilised road-bases (CB1 and CB2) as described in TRL ORN31. Hence, the use of L-GGBS combination was found to be effective in ameliorating sulphate-induced expansion and therefore encouraged in the stabilisation of subgrade and road-base materials with high sulphate contents.

Biosynthesis and biophysical elucidation of CuO nanoparticle from Nyctanthes arbor-tristis Linn Leaf.

Copper oxide nanoparticles (CuO NPs) synthesis using an environmentally benign approach, as well as their antibacterial properties. Copper sulphate pentahydrate (CuSO4.5H2O) of different concentrations (2 mM, 5 mM and 10 mM) and aqueous Nyctanthes arbor-tristis leaf extract were used to make the CuO NPs. The synthesised CuO NPs are characterised by UV-vis spectroscopy, X-ray diffractometer (XRD), Fourier-transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM). UV-vis spectroscopy confirmed the presence of CuO NPs. The functional groups of the active components were identified using the FTIR spectra of the control (leaf extract) and CuO NPs. SEM pictures revealed that the particles were rectangular, truncated triangle and spherical in shape, with sizes ranging between 4.9 nm, 18.4 nm and 23.8 nm determined using X-ray diffraction. The antibacterial activity of the produced CuO NPs was further evaluated using the well diffusion method. By observing inhibition zones around each well, the nanoparticles were revealed to have broad antibacterial action against human pathogenic bacterial strains Escherichia coli and Staphylococcus aureus withs the 7 ± 0.70-mm and 7 ± 0.21-mm inhibitory zone size respectively followed by 08 µg/mL and 2.5 µg/mL MIC respectively. Thus, these outputs concluded that the CuO NPs exhibited miraculous effect and it might be boon towards nanomedical science, pharmaceuticals and health industries. KEY POINTS: • Biosynthesis of CuO nanoparticle • Multifaceted utilization • Broad spectrum antimicrobial activity.

Anemia and Nutritional Status in Tuberculosis Patients.

INTRODUCTION: Anemia is a common complication of pulmonary tuberculosis (TB). Nutritional deficiency and malabsorption syndrome can deepen the severity of anemia. The aim of the present study was to study anemia and nutritional status in patients with TB at a tertiary care center. MATERIALS AND METHODS: All patients diagnosed with TB (pulmonary and extrapulmonary), registered withRevised National TB Control Programme (RNTCP), taking DOTS regimen, attending the outpatient department as well as those admitted in the medicine and chest units of a tertiary care hospital, were enrolled in the present study. RESULTS: Anemia was more common between the age groups of 51 and 60 years, with distribution of males (87 [58%]), patients with diabetes (49 [32%]), and hypertensive patients (29 [19.3%]). In our study, 48 (85.7%) out of 56 patients diagnosed with extrapulmonary TB were found to have anemia; similarly, 77 (88.5%) out of 87 patients diagnosed to have pulmonary TB were anemic. Anemia of chronic disease (128 [97.17%]) was higher when compared to that of those with iron-deficiency anemia (3 [2.29%]). According to body mass index (BMI), 135 (90%) patients were underweight; according to mid-arm circumference (MAC), 131 (87.3%) patients had severe malnutrition; and according to waist-hip ratio [WHR], 96 (64%) patients were underweight. CONCLUSION: Anemia was common in males and alcoholics, and there was a high prevalence of anemia of chronic disease. In addition, anemia was associated with high erythrocyte sedimentation rate and C-reactive protein. High proportions of TB patients (pulmonary and extrapulmonary) were classified as underweight and malnourished on the basis of different parameters (BMI, MAC, and WHR); in addition, the degree of malnutrition was higher in patients with anemia than in those without.

Comparison of Tocilizumab and High-dose Methylprednisolone Pulse on Outcomes in Severe Corona Virus Disease-2019: TAME-COVID, a Retrospective Multicentric Study.

BACKGROUND: India recently encountered fierce second wave of coronavirus disease (COVID-19), and scarcity of novel medications added to the management challenges. Various studies have highlighted the effectiveness of tocilizumab and high-dose steroids in severe COVIDs, but none has compared their efficacy. MATERIALS AND METHODS: This retrospective multi-centric analysis compares intravenous tocilizumab (8 mg/kg/day, maximum dose-800 mg), and intravenous Methylprednisolone Pulse (MPS-1 g/day for 3 days) in severe COVID-19. Both the groups had additionally received the standard of care COVID treatment as per protocol. Outcomes were assessed at 30 days. RESULTS: A total of 336 patients, with 249 receiving MPS and 87 receiving tocilizumab were compared. Majority of these were males (72.9%) with a mean age of 57.4 ± 13.6 years. Diabetes was the most common comorbidity. Patients in both groups had comparable age distribution, comorbidities, presenting mean-arterial pressures, d-Dimer levels, serum ferritin, serum leukocyte-dehydrogenase, and procalcitonin. However, the tocilizumab group had more number of males, higher incidence of coronary artery disease, more tachypnea and leukocytosis, more number of patients with severe acute respiratory disease syndrome (PaO2/FiO2 ratio <100), and higher C-reactive protein levels at presentation. Both groups had comparable adverse events' profile. Tocilizumab group had lesser requirement of invasive ventilation than MPS group (17% vs. 29%, P = 0.038), however mortality at the end of 30 days follow-up was similar (36% vs. 34% respectively; P = 0.678). CONCLUSIONS: Tocilizumab decreased the need for invasive ventilation in severe COVID-19; however, it did not translate to improved survival. A planned prospective randomized study is recommended in this respect to compare their efficacy.

Prognostic Role of B-Type Natriuretic Peptide in Adults with Acute Dyspnea Requiring Emergency Admission.

OBJECTIVE: The aim of the study was to evaluate the role of B-type natriuretic peptide (BNP) in patients presenting with acute dyspnea admitted in emergency services. MATERIALS AND METHODS: A prospective observational study was conducted on 100 patients presenting to the emergency of Dayanand Medical College and Hospital and Hero DMC Heart Institute with acute dyspnea of <48 h duration, in which BNP levels were done on arrival to emergency. RESULTS: BNP levels were significantly higher in patients having left ventricular dysfunction, both systolic and diastolic. Patients with systolic dysfunction had slightly higher BNP (1251.50 ±950.14 pg/mL) compared to patients with diastolic dysfunction (905.62±618.10 pg/mL) though statistically insignificant (P = 0.055). BNP levels were also inversely related to ejection fraction. Mean BNP levels in patients with EF <31%, 31%-45%, 46%-59%, and ≥60% were 1464.63 ± 1058.29, 968.24 ± 751.59, 841.64 ± 503.41 and 781.67 ± 504.21 (P = 0.009), respectively. Patients having higher BNP levels had significantly prolonged duration of stay compared to patients with lower BNP. Patients who expired had slightly higher levels of BNP though statistically nonsignificant. BNP had no significant statistical relation with age, heart rate, creatine phosphokinase-MB, Trop-T levels, systolic blood pressure. CONCLUSION: We conclude that high BNP levels are a marker of cardiac dysfunction and increased duration of hospital stay in patients presenting to the emergency with acute dyspnea. Hence, BNP can be used as a screening test for the evaluation and management of dyspnea.

Assessing the feasibility of integrating ecosystem-based with engineered water resource governance and management for water security in semi-arid landscapes: A case study in the Banas catchment, Rajasthan, India.

Much of the developing world and areas of the developed world suffer water vulnerability. Engineering solutions enable technically efficient extraction and diversion of water towards areas of demand but, without rebalancing resource regeneration, can generate multiple adverse ecological and human consequences. The Banas River, Rajasthan (India), has been extensively developed for water diversion, particularly from the Bisalpur Dam from which water is appropriated by powerful urban constituencies dispossessing local people. Coincidentally, abandonment of traditional management, including groundwater recharge practices, is leading to increasingly receding and contaminated groundwater. This creates linked vulnerabilities for rural communities, irrigation schemes, urban users, dependent ecosystems and the multiple ecosystem services that they provide, compounded by climate change and population growth. This paper addresses vulnerabilities created by fragmented policy measures between rural development, urban and irrigation water supply and downstream consequences for people and wildlife. Perpetuating narrowly technocentric approaches to resource exploitation is likely only to compound emerging problems. Alternatively, restoration or innovation of groundwater recharge practices, particularly in the upper catchment, can represent a proven, ecosystem-based approach to resource regeneration with linked beneficial socio-ecological benefits. Hybridising an ecosystem-based approach with engineered methods can simultaneously increase the security of rural livelihoods, piped urban and irrigation supplies, and the vitality of river ecosystems and their services to beneficiaries. A renewed policy focus on local-scale water recharge practices balancing water extraction technologies is consistent with emerging Rajasthani policies, particularly Jal Swavlamban Abhiyan ('water self-reliance mission'). Policy reform emphasising recharge can contribute to water security and yield socio-economic outcomes through a systemic understanding of how the water system functions, and by connecting goals and budgets across multiple, currently fragmented policy areas. The underpinning principles of this necessary paradigm shift are proven and have wider geographic relevance, though context-specific research is required to underpin robust policy and practical implementation.

Total scalp reconstruction following a dog bite in a pediatric patient.

The purpose of this case report is to present the reconstruction of a full-thickness scalp defect in a 2-year-old Hispanic male mauled by a dog, which was performed by a novel technique. After the scalp defect was debrided multiple times and treated with greater than 600 cm2 of cryopreserved human skin allograft, Integra was applied to the scalp defect following debridement and burring-out the outer bony cortex to promote bleeding and integration, followed by the application of a VAC dressing. Four weeks later, the mature Integra was grafted with split-thickness grafts. One year after the original injury, the patient demonstrated 98% take of the skin grafts to the calvarium. The resultant soft-tissue cover was supple, pliable, uniform in texture, and stable. The proposed technique of reconstruction of large full-thickness scalp defects in pediatric patients is easily reproducible, involves a short operative time, and produces satisfying cosmetic results.

Biomedical approaches to improve bone healing in distraction osteogenesis: a current update and review.

Induction of new bone formation through distraction osteogenesis (DO) has widespread clinical applications in the treatment of bone defects, limb deformities, and fracture nonunion. However, a lengthy period of external fixation is usually needed to allow the new bone to consolidate, and complications such as refracture at the distraction gap are often seen. To date, little has been reported on the use of biomaterials as carrier materials for sustained release of growth factors in bone regeneration. One area of focus is the delivery of osteogenic factors in an attempt to modulate the formation of bone. These applications allow the efficient delivery of osteogenic growth factors directly into the defect site, resulting in localized drug delivery and reducing possible toxic systemic effects. However, studies on these biomaterials have only just begun; there are still many unanswered questions and unexplored frontiers that can greatly influence the role of nanostructured materials as improved bone implants. This review article seeks to demonstrate the potential of biomaterials to improve biological applications pertinent to osteodistraction.

A novel device for long bone osteodistraction: description of device and case series.

The purpose of this study was to present a novel intramedullary device (M-Bone; Phenix, Paris, France) that contains a mechanism for internal osteodistraction and bone transport in patients with segmental bone defects or limb length discrepancy after limb salvage operations. A total of five patients with primary bone tumors were enrolled in the study. After implantation, daily lengthening was performed in an outpatient setting either by the patient or with the help of a therapist, without the use of anesthesia. This unique device offers a totally new approach for the treatment of segmental bone defects or limb length discrepancy. It is designed to expand the remaining native bone by a magnetically activated drive system and induces new bone formation using osteodistraction and bone transport.

Bilateral chylothorax, chylopericardium and chylous ascitis.

Non-Hodgkin's lymphoma (NHL) can commonly present as chylothorax and rarely as chylopericardium. Here we are presenting a case of a 21-years-old female with bilateral chylothorax, chylopericardium and chylous ascites all together finally diagnosed to have NHL as the etiology. To the best of our knowledge, it has been reported very infrequently.

Diffuse alveolar hemorrhage in Wegener's granulomatosis.

Diffuse alveolar hemorrhage is a life-threatening though rare manifestation of Wegener's granulomatosis (WG). An active diagnostic workup, intensive observation, and aggressive immunosuppressive treatment are cornerstones of the management. The treatment modalities available for such complications are pulse cyclophosphamide therapy with steroids. We report here a case of WG with diffuse alveolar hemorrhage as the first manifestation of the disease in life that responded to steroids and cyclophosphamide.

Pulmonary embolism in cases of pulmonary tuberculosis: a unique entity.

Pulmonary tuberculosis is very prevalent in developing countries but its thrombogenic potential is a new entity. There are reports stating the relation of Deep Vein Thrombosis (DVT) with severe forms of tuberculosis but no literature is available for correlation of pulmonary tuberculosis and pulmonary embolism. We are presenting series of five patients with different forms of tuberculosis presenting with pulmonary embolism having no risk factor for hypercoagulability. Also, serum protein C, protein S, antithrombin and factor V levels were normal in all. We are highlighting an unreported phenomenon so that high suspicion, adequate prophylaxis and prompt management of pulmonary embolism can play a vital role in the survival of this subset of patients.

Erythema nodosum: Atypical presentation of common disease.

Tuberculosis is a very common disease often presenting in an uncommon form. High level of suspicion is required to diagnose it, thereby preventing its morbidity and mortality. We present a case of young female with multiple tuberculo-protein hypersensitivity reactions without any evidence of active tuberculosis in the body.

Follicular lymphoid hyperplasia of the palate: case report and literature review.

Follicular lymphoid hyperplasia (FLH) of the palate is a very rare benign, proliferative process, with only 20 cases published so far in the English language literature. We describe a case, in a 55-year-old Caucasian female, who developed a swelling in the left posterior hard palate. Bony involvement was absent. Importantly, the medical history was positive for a previous non-Hodgkin lymphoma. Following incisional biopsy, histological examination revealed a vaguely nodular lymphoid proliferation composed of small well-differentiated lymphocytes. The lymphoid follicles were positive for CD20, CD79a, CD10, CD21 and BCL6, while negative for BCL2. The parafollicular areas revealed positivity for CD3, CD5, CD30, and CD15. Both areas were CD45 positive. Subsequent immunoglobulin heavy chain gene rearrangement analysis revealed a polyclonal lesion. No further treatment was instituted, and the patient is currently being followed-up every three months. This report demonstrates that FLHs are especially important due to their clinical and, occasionally, microscopic resemblance to follicular lymphomas. Morphologic and immunohistochemical analyses and molecular studies are essential to achieve accurate diagnosis and to implement appropriate management.