Platelet Indices as Novel Surrogate Markers for the Prognosis of COVID-19 Infection: An Observational Study.

Background  The new severe acute respiratory syndromecoronavirus 2 (SARS-CoV-2) causes severe acute respiratory illness accountable for causing the coronavirus disease 2019 (COVID-19) illness. Thrombotic issues, acute respiratory distress syndrome (ARDS), and cytokine storm are significant contributors to morbidity and mortality in patients with COVID-19. Elevated D-dimer levels and prothrombin times are further indicators of abnormal coagulation parameters in COVID-19 patients. This study aimed to study the platelet indices as prognostic markers in COVID-19 infection. Methods In this prospective observational study, 150 real-time reverse transcription-polymerase chain reaction (RT-PCR)-positive COVID-19 patients were enrolled between October 2020 and September 2021. All the subjects were screened and explained the study procedure in their native language. Following enrolment, a detailed history and physical examination were performed. Subsequently, laboratory investigations were performed, and patients were subjected to high-resolution computed tomography (HRCT) examination to classify patients into mild, moderate, and severe according to the severity of the illness. The platelet indices taken into account were plateletcrit (PCT) in percentage, platelet count (PLT) in lakh per microlitre, mean platelet volume (MPV) in femtolitres, and platelet distribution width (PDW) in femtolitres. Results The mean PLT was significantly greater among survivors than non-survivors (2.03 ± 0.72 versus 1.76 ± 0.47; p-value = 0.018). The mean MPV (10.42 ± 0.53 versus 9.22 ± 0.64; p-value <0.0001) and PDW (17.99 ± 1.53 versus 16.54 ± 0.91 fl; p-value <0.0001) were significantly greater among non-survivors than survivors. However, the mean PCT was significantly greater among survivors than non-survivors (0.22 ± 0.03% versus 0.18 ± 0.33%; p-value <0.0001). At a cut-off of 0.213, the sensitivity and specificity of PCT in predicting death were found to be 79.2% and 74.5%, respectively. At a cut-off of 16.75, the sensitivity and specificity of PDW in predicting death were found to be 68.8% and 59.8%, respectively. The findings demonstrated a relationship between elevated MPV and PDW and mortality and severe COVID-19 infection. Increased PCT was connected to higher survival, with a specificity and sensitivity of 87.5% and 75.5%, respectively, and MPV >9.75 may predict death. PDW >16.75 exhibited a specificity and sensitivity of 68.8% and 59.8%, respectively, in predicting death. With comparable sensitivity and specificity of 79.2% and 74.5%, PCT >0.213 may predict death. Conclusion In severely sick COVID-19 patients, platelet indices should be routinely calculated and can be utilized as simple, low-cost prognostic indicators.

Visceral Adiposity Index in Type 2 Diabetes Mellitus (DM) and Its Correlation With Microvascular Complications.

Background Obesity, specifically abdominal obesity, is a major risk factor for diabetes. A strong association has been marked between diabetes and obesity. Many abdominal obesity indices have been established, including waist circumference (WC), BMI, and a new tool, the visceral adiposity index (VAI). However, very limited research highlights the association of these anthropometric parameters and VAI to the various microvascular complications of diabetes mellitus (DM). The objective of this study is to investigate the association of VAI with microvascular complications such as retinopathy, nephropathy, and neuropathy in type 2 DM (T2DM) patients. Methodology Data from Acharya Vinoba Bhave Rural Hospital (AVBRH) was analyzed in this case-control study with a sample size of 250 patients consisting of 125 cases and 125 controls. The cases and controls were age- and gender-matched. BMI and WC were measured in these patients, and the VAI was calculated. These anthropometric parameters were then analyzed to estimate their correlation with the microvascular complications of T2DM. Results The mean age of cases in this study was 58.37 ± 12.08 years and that of controls was 57.61 ± 14.51 years. Anthropometric parameters, namely, BMI, WC, and VAI were raised in cases as compared with controls, and they showed significant statistical relation with diabetes (for BMI, P = 0.003; for WC, P = 0.001 for males and P = 0.002 for females; and for VAI, P = 0.005). A significant correlation was noted in the high-density lipoprotein (HDL) cholesterol (P = 0.017 for males and P = 0.0004 for females) and triglyceride (TG) levels (P < 0.0001) between cases and controls. On distributing the male and female cases in quartiles, it was observed that with increasing quartiles, VAI increased significantly and was associated with an increased risk of microvascular complications such as retinopathy, nephropathy, and neuropathy. When the anthropometric parameters and VAI were compared with the total microvascular complications and the receiver operating characteristic curve studied, VAI had the maximum AUC (AUC for VAI was 0.826, WC was 0.813, and BMI was 0.806). Univariate analysis of the various microvascular complications showed that WC, BMI, HDL, TGs, and glycated hemoglobin (HbA1c) were all significantly correlated to the microvascular complications in T2DM patients. Conclusions As the VAI was significantly raised in T2DM patients and also seen to be significantly associated with microvascular complications, it could be used as a screening tool for T2DM patients.

Microfilaria causing nephrotic syndrome: Highlighting the importance of diethylcarbamazine provocation test for diagnosis.

Filarial parasite infestation not only affects the structure and function of lymphatic vessels but is also associated with extralymphatic pathology and disease. Incidence of renal involvement in microfilaria carriers has led to increased cognizance of extralymphatic presentation. Literature set forth clinical syndromes having extralymphatic manifestation of filaria. The diagnosis of filariasis is done by visualisation of microfilaria in peripheral blood smear, lymphatic tissue. Other modalities of diagnosis are Enzyme linked immunosorbent assay (ELISA), Immunochromatographic test. Diethyl carbamazine (DEC) provocation test usually is done to detect microfilaria in night blood smear due to the nocturnal periodicity of microfilaria. The drug DEC flushes the microfilaria into the peripheral circulation leading to high probability of detection. We present a case of a 59-year-old male who was diagnosed as nephrotic syndrome and after a DEC challenge we detected microfilaria in the peripheral smear confirming microfilaria-induced Nephrotic Syndrome after all other secondary conditions were excluded.

An Unusual Presentation of a Corpus Luteum Rupture.

Rheumatic heart disease (RHD) is one of the most common cardiac conditions seen in India with mitral stenosis as the most prevalent cause affecting females more than males. With the increasing number of patients undergoing mitral valve replacement (MVR) and mandatory use of anticoagulants post-MVR, the patients presenting with drug-induced coagulopathy have increased. One of the rare complications of coagulopathy-related hemorrhage may be associated with a gynecological cause with maximum risk in women of reproductive age group. This chance of hemorrhage has increased due to various events that occur in reproductive organs, namely, ovulation, menstruation, trauma due to sexual intercourse, or pregnancy-related bleeding. Such bleeding is evident as external vaginal bleeding or hemoperitoneum. Hereby, we present a rare case of a 30-year-old woman, on anticoagulant therapy for MVR who presented with congestive cardiac failure associated with massive hemoperitoneum. On ultrasound-guided paracentesis, the cause of mild-to-moderate ascites was normal ovulatory bleed evident by the bleeding from the corpus luteal cyst.

Lightning Strike-Induced Myocarditis.

Lightning strikes are frequently encountered and are a major cause of morbidity and mortality. It could impair several organs, but the effects of electric current on the cardiovascular system contribute to the primary cause of cardiorespiratory arrest. These effects can be either transient or persistent, ranging from benign or life-threatening arrhythmias, ischemic injury, myocardial contusion, aortic injury, cardiomyopathy, and ventricular failure. Myocarditis has been an important but not very well-understood cause of cardiac dysfunction. Fulminant myocarditis is defined as patients presenting with severe heart failure, having a duration of <2 weeks of symptoms, and requiring inotropic or mechanical circulatory support. This condition can rapidly lead to hemodynamic instability and death. Resuscitation for a longer time increases the probability of favorable outcomes in young and previously healthy patients. This case report accounts for a case of a healthy young male who was struck by lightning while working on the farm and developed electrocardiographic changes along with positive cardiac biomarkers.

Acute Chest Syndrome, Avascular Necrosis of Femur, and Pulmonary Embolism All at Once: An Unexpected Encounter in the First-Ever Admission of a Sickle Cell Patient.

Acute chest syndrome (ACS) is defined as the radiological appearance of pulmonary infiltrates with fever or respiratory symptoms like chest pain, breathlessness, and cough in a patient with sickle cell disease (SCD). It is also a very common cause of mortality in sickle cell patients, if not identified in early stages and treated aggressively. Radiological image is similar to bacterial pneumonia, so sickle cell disease with a radiological picture similar to pneumonia and associated respiratory symptoms is known as acute chest syndrome. Pneumonia and infarction have been implicated in pathogenesis. The reason for the appearance of acute chest syndrome in patients with SCD is not established but some triggers like sepsis, presence of vaso-occlusive crises have been noted. When there is a block in the blood supply to the bone, patients with sickle cell disease may also develop avascular necrosis of the neck of the femur causing narrowing of joint and collapse of the bone. Patients with sickle cell disease have a baseline hypercoagulable state thereby predisposing the patient to develop deep vein thrombosis and pulmonary embolism. Here, we present a case of a 25-year-old SCD patient with a fairly stable course of the disease. He had no history of prior admissions and he had his first-ever episode of sickle cell crisis lading in with acute chest syndrome, avascular necrosis of femur, and pulmonary embolism all at once. After an extensive review of the literature, we found this to be the first case report in the world where all these three complications of sickle cell disease developed simultaneously in a patient.