Can blood glucose levels predict biochemical and haematological abnormalities in COVID -19 patients - Experience from a tertiary care hospital in Balochistan.

OBJECTIVE: To find out the association between poor glycaemic levels and biochemical and haematological abnormalities in patients of corona virus disease-2019. METHODS: The prospective, observational, cohort study was conducted at the Combined Military Hospital, Quetta, Pakistan, from September 2020 to February 2021, and comprised all patients who tested positive for coronavirus disease-2019 on polymerase chain reaction test and were subsequently admitted. The patients were divided into two groups on the basis of random blood glucose level at the time of admission; ≥11.1mmol/l (206mg/dl) in group A and 4-11.1mmol (74-206mg/dl) in group B. Association between categorical variables was evaluated and hazard ratio was measured. Data was analysed using SPSS 21. RESULTS: Of the 349 patients, there were 56(16%) in group A; 40(71.4%) males and 16(28.6%) females with age range 39-61 years. There were 293(84%) subjects in group B; 239(81.5%) males and 54(18.5%) females with age range 27-53 years. Overall, 75(21.4%) patients were known type 2 diabetics. A significant association was found between poor glycaemic control and raised levels of C-reactive protein, lactate dehydrogenase, ferritin, erythrocyte sedimentation rate, troponin, creatine kinase, creatine kinase-MB, alanine aminotransferase, creatinine and D-dimers (p<0.05). Inter-group differences were significant for acute kidney injury, acute liver injury, Intensive care unit admission for coagulation abnormalities and for overall mortality (p<0.05). CONCLUSIONS: Poor glycaemic control was found to be a risk factor for developing multisystem complications in patients of coronavirus disease-2019.

Increased TGFß1 and SMAD3 Contribute to Age-Related Aortic Valve Calcification.

Aims: Calcific aortic valve disease (CAVD) is a progressive heart disease that is particularly prevalent in elderly patients. The current treatment of CAVD is surgical valve replacement, but this is not a permanent solution, and it is very challenging for elderly patients. Thus, a pharmacological intervention for CAVD may be beneficial. In this study, we intended to rescue aortic valve (AV) calcification through inhibition of TGFß1 and SMAD3 signaling pathways. Methods and Results: The klotho gene, which was discovered as an aging-suppressor gene, has been observed to play a crucial role in AV calcification. The klotho knockout (Kl -/-) mice have shorter life span (8-12 weeks) and develop severe AV calcification. Here, we showed that increased TGFß1 and TGFß-dependent SMAD3 signaling were associated with AV calcification in Kl -/- mice. Next, we generated Tgfb1- and Smad3-haploinsufficient Kl -/- mice to determine the contribution of TGFß1 and SMAD3 to the AV calcification in Kl -/- mice. The histological and morphometric evaluation suggested a significant reduction of AV calcification in Kl -/-; Tgfb1 ± mice compared to Kl -/- mice. Smad3 heterozygous deletion was observed to be more potent in reducing AV calcification in Kl -/- mice compared to the Kl -/-; Tgfb1 ± mice. We observed significant inhibition of Tgfb1, Pai1, Bmp2, Alk2, Spp1, and Runx2 mRNA expression in Kl -/-; Tgfb1 ± and Kl -/-; Smad3 ± mice compared to Kl -/- mice. Western blot analysis confirmed that the inhibition of TGFß canonical and non-canonical signaling pathways were associated with the rescue of AV calcification of both Kl -/-; Tgfb1 ± and Kl -/-; Smad3 ± mice. Conclusion: Overall, inhibition of the TGFß1-dependent SMAD3 signaling pathway significantly blocks the development of AV calcification in Kl -/- mice. This information is useful in understanding the signaling mechanisms involved in CAVD.

Tonsillar Surface Micro Flora: Does it Truly Represent Pathological Tonsillar Flora?

OBJECTIVE: To determine the best method of identifying core tonsillar flora. STUDY DESIGN: Quasi-experimental study. PLACE AND DURATION OF STUDY: ENT Department, Combined Military Hospital, Lahore, from September 2013 to October 2015. METHODOLOGY: Eighty-seven patients of recurrent tonsillitis undergoing tonsillectomy were included. All the patients, after being anaesthetised, had surface swabs taken from the tonsillar surface followed by tonsillar aspiration with a 5cc syringe. Following tonsillectomy, the tonsils were sent for culture of core flora. All three specimens from each patient were cultured according to established criteria. RESULTS: The patient population had 33 (37%) female and 54 (62%) male patients. Flora of 12 (13.8%) surface swabs and 68 (78.2%) tonsillar aspirates matched the flora cultured from core of the tonsils. Chi-square test showed this difference to be significant (p-value <0.001). CONCLUSION: Tonsillar aspiration gave a much more realistic picture of the tonsillar core flora as compared to surface swabs.

Carotid body paraganglioma.

Carotid body tumours are benign neoplasms. This case report describes two patients with this rare tumour with diagnostic workup and treatment options. The first case was a 36-year-old gentleman who presented with 6 months history of painless swelling on the left side of neck. The second patient was 60-years-old man who presented with slowly growing swelling on the right side of neck for the last 20 years. Both patients had transmitted pulsations over the swelling. On suspicion of a vascular lesion, a contrast enhanced CT scan and Doppler's ultrasound of neck was advised which suggested the diagnosis of a carotid body tumour. Magnetic Resonance Angiography (MRA) confirmed the diagnosis. Excision in collaboration with vascular surgeon was planned for the first case. The second case was subjected to radiation therapy due to the large size of tumour and the patient's age.