Effectiveness of Convalescent Plasma Therapy in Moderate to Severely Ill Covid-19 Patients.

Convalescent plasma therapy, a classic adaptive immunotherapy used in the treatment of SARS, MERS, and 2009 H1N1 pandemic with acceptable efficacy and safety in the past. Convalescent plasma therapy was taken into consideration in management of COVID 19 disease during the initial days of pandemic but was withdrawn later due to its doubtful beneficial role. This study aims to explore the beneficial role of convalescent plasma and to determine whether convalescent plasma therapy holds a second chance in treating SARS COV-2. MATERIAL: This cross-sectional observational study includes 82 cases of moderate to severely ill COVID 19 patients who received convalescent plasma therapy and 41 controls who didn't. Regular monitoring of TLC, P/F ratio, N/L ratio inflammatory markers, respiratory rate, oxygen saturation, ABG and radiological imaging was done for comparative analysis. OBSERVATION: In case group 39 patients (47.56%) were on oxygen mask, 17 patients (20.73%) on NIV, 9 Patients on NRM (10.97%), 16 patients (19.51%) on room air, 1(1.21%) on HFNC initially. After 7th day of convalescent plasma therapy 49 patients (59.75%) were on room air which suggests significant improvement in mode of ventilation in case group as compared to control group. Mean respiratory rate in case group was 30.46 CPM initially and 24.7 CPM on day 7th of plasma therapy which is statistically significant. CONCLUSION: Plasma therapy is effective if given in early stage of disease and convalescent plasma donors having adequate antibody titre.

Low Serum Testosterone Levels in Male Patients with Type 2 Diabetes Mellitus as a Risk Factor for Coronary Artery Disease.

BACKGROUND: Diabetes mellitus is a chronic debilitating illness associated with several complications of which hypogonadism in male patients with type 2 diabetes mellitus (T2DM) is often overlooked but carries a high prevalence and possibly associated with several co-morbidities. OBJECTIVES: To study the correlation of serum testosterone with clinical and biochemical factors in male patients with type 2 diabetes mellitus. METHOD: In our cross-sectional study, we selected a group of 100 patients with type 2 diabetes mellitus (50 each with hypogonadism and 50 with eugonadism) and obtained their biochemical parameters and looked for the prevalence of co-morbid conditions. We did a correlation of serum testosterone with each quantitative variable using Pearson's Coefficient of correlation and multivariable logistic regression analysis was applied. RESULT: Serum testosterone levels were found to be correlated with age, waist circumference, fasting blood sugar, serum triglycerides and eGFR (p<0.05).The prevalence of coronary artery disease was higher in T2DM male patients with hypogonadism as compared eugonadal patients. We found higher odds (1.33 times) for coronary artery disease in male patients with hypogonadism and T2DM as compared to males with T2DM and eugonadism. CONCLUSION: There is a higher risk of coronary artery disease in male patients with T2DM and hypogonadism as compared to males with T2DM and eugonadal status.

Exercise Prescription in Diabetes- S.M.A.R.T.: A Prospective Study.

BACKGROUND: Exercise prescription has always been a mandatory yet extremely under rated non-pharmacological approach in management of diabetes mellitus. SMART acronym for S - specific, M - measurable, A - attainable, R - realistic, T - time oriented, is a newly proposed idea for implementing the same with supposedly better results. We tried to analyse the results objectively by SMART prescription of individualized exercise regimes to patients along with medicines. METHODS: Single centred, prospective study conducted over a time span of 3 months, on 75 patients, with biweekly follow-up. At the end of three months, we evaluated the results (of 52 patients who remained) by comparing random blood sugar and glycosylated haemoglobin values of the patients at the beginning and end of the trial. RESULTS: A significant reduction in blood sugar (p-0.023) and A1C levels (p-0.105; ns) was noted after a period of three months; with an average reduction of 31mg/ dl and 0.37% noted in each respectively. Additional benefits of better follow up, reduced financial burden, increased compliance to the said regimen were observed. DISCUSSION: Recommending exercise and lifestyle changes is as important as pharmacological management in diabetes. A SMART approach, methodical prescription of the exercise routines and drugs- individualized for patients, will likely have better results and patient satisfaction. A practice of switching to precise written suggestions than verbal ideas and reviewing the progress on every follow up visit may improve the outcome.

Study of Diversity of Metformin Related Gastrointestinal Side Effects.

INTRODUCTION: Digestive disorders represent the most common metformin related side-effects in type 2 diabetics. GI side effects of metformin are not so uncommon rather under reported or wrongly diagnosed as primary gastrointestinal disorder. This study is to estimate metformin related GI side effects in Indian population. METHODOLOGY: This is a retrospective cross sectional study, conducted in tertiary care hospital at Kota. 120 type 2 diabetic patients were included after detailed history, physical examination and inclusion/exclusion criteria, who were on metformin tablet only, for variable duration. All patients were evaluated for gastrointestinal side effects. RESULTS: Mean age of study group was 52.8±11.9 years with mean weight 72.4±10.3 kg. Mean duration of metformin therapy was 3 years (6 weeks to 6 years) and mean metformin dose was 1000mg (500 mg - 2500 mg). 62 (51.66%) patients presented with GI side effects. These side effects are diarrhea (33), nausea/vomiting (28), pain abdomen (23), flatulence (16), retching (13), dysgeusia (7). On the basis of duration of therapy, most of patients had side effects during initial phase of treatment but some patients also presented after long duration of treatment. CONCLUSION: Gastrointestinal side effects being most common side effect of metformin can lead to discontinuation of therapy. So before extensive evaluation of any GI problem in patient on metformin, other methods can be tried like temporary discontinuation, dose titration or proper intake of medicine. These side effects may also occur even after prolonged treatment with metformin.

COVID 19- Clinical Profile, Radiological Presentation, Prognostic Predictors, Complications and Outcome: A Perspective from the Indian Subcontinent.

BACKGROUND: Since December 2019, we have been facing one of the worst pandemics of human history. It originated from the Hubei province in China as a case of pneumonia, later named COVID-19.1 The causative pathogen, a new enveloped betacoronavirus2 is now known as Severe acute respiratory syndrome corona virus-2 (SARS-CoV 2). India reported its first case of COVID19, on 30th January 2020. We aim to identify the defining clinical and radiological characteristics, severity and prognosis, along with impact of age on outcome. METHODS: Cross sectional, observational study of patients diagnosed with COVID -19 [RT-PCR]. RESULTS: We observed male predominance, mean age of 36 years, with less or no symptoms, majority brought in after screening and contact tracing by the screening teams. Thrombocytopenia, lymphocytosis, raised LDH was common (>35%, p<0.05). Patients over the age of 60 were the ones having severe illness and more complications (p<0.05). Radiographic abnormality was frequently associated irrespective of clinical presentation and its severity. Poor prognosis was noted in elderly, especially those with co-morbidities. DISCUSSION: Though the disease has a relatively mild course in this part of the subcontinent, patients aged ≥60 are at significant risk for morbidity and mortality. Clinical and laboratory findings are similar to those found in viral diseases. Increased risk of cardiac involvement needs to be looked into. Chest X-ray proves sufficient for imaging, reducing the requirement of CT scans. Studies involving larger sample size and interventional trials are need of the hour.

Association between Non- alcoholic Fatty Liver Disease and Left Ventricular Diastolic Dysfunction in Patients of Type 2 Diabetes.

OBJECTIVE: The purpose of the study was to assess if non-alcoholic fatty liver disease (NAFLD) in diabetic patients increases the risk and/or severity of diastolic dysfunction. RESEARCH DESIGN AND METHODS: We studied 70 type 2 diabetic individuals without a history of ischemic heart disease, hepatic diseases, or excessive alcohol consumption, in whom NAFLD was diagnosed by ultrasonography. All patients had normal left ventricular systolic function and blood pressure values under medication. Left ventricular diastolic dysfunction was assessed by pulsed wave Doppler and tissue Doppler imaging, studying mitral inflow patterns and E wave, E' wave velocities, E/A and E/E' ratios. RESULTS AND CONCLUSIONS: Fifty seven patients (81.43%) had NAFLD, and when compared with the other 13(18.57%) patients, age, sex, BMI, waist circumference, hypertension, smoking, diabetes duration, microvascular complication status, and medication use were not significantly different. In addition, the left ventricular (LV) mass and volumes, ejection fraction, systemic vascular resistance, arterial elasticity, and compliance were also not different. NAFLD patients had lower E' (8.42±0.89 vs.9.72±0.54, P <0.0001) tissue velocity, higher E-to-E' ratio (9.64±1.83 vs. 7.78±0.89, p<0.001), higher LV-end diastolic pressure (EDP) (15.52 ± 0.69 vs. 14.40±0.9 p <0.0001), higher LV EDP/end diastolic volume LV EDP/EDV (mmHg/ mL) (0.19 ±0.15 vs. 0.17±.02 p < 0.001) and higher glycosylated haemoglobin (HbA1C) (8.53±1.02 vs.7.65±0.66 p<0.01) than those without steatosis. All of these differences remained significant after adjustment for hypertension and other cardio metabolic risk factors. Our data show that in patients with type2 diabetes and NAFLD, even if the LV morphology and systolic function are preserved, early features of LV diastolic dysfunction detected. The frequency of diastolic dysfunction was significantly higher in diabetic patients with NAFLD versus controls.

Study of Impact of Glycemic Status (HbA1c) on Platelet Activity measured by Mean Platelet Volume & Vascular Complications in Diabetics.

INTRODUCTION: Diabetes mellitus is a global pandemic. The increased platelet activity may play a role in the development of vascular complications of this metabolic disorder. The mean platelet volume (MPV) is an indicator of the average size and activity of platelets. Larger platelets are younger and exhibit more activity. AIMS AND OBJECTIVES: To determine the MPV in diabetics with different glycemic control (HbA1C), to see if there is a difference in MPV between diabetics with and without vascular complications, and to determine the correlation of MPV with fasting blood glucose, glycosylated hemoglobin (HbA1c), body-mass index, and duration of diabetes in the diabetic patients. METHODOLOGY: Platelet counts and MPV were measured in 160 Type 2 diabetic patients using an automated blood cell counter. The blood glucose levels and HbA1c levels were also measured. All patients were divided in 2 groups, group A, which includes patients with HbA1C≤8 % and group B, which includes patients with HbA1C>8 %. Statistical evaluation was performed using Student's t test and Pearson correlation tests. RESULTS: The mean platelet counts and MPV were higher in diabetics with higher HbA1C (group B) compared to the diabetics with lower HbA1C (group A) [288.30 ± 103.96 X 109/l vs. 265.83 ± 66.97 X 109/l (P= 0.16)], 13.77 ± 0.08 fl versus 11.86 ± 0.66 fl (P= 0.0001), respectively. MPV showed a positive correlation with fasting blood glucose (regression (r) = 0.18) and HbA1C levels (P=0.0001). HbA1C and MPV increases with increase in duration of DM, which were 8.62±0.96 and 8.51±1.09 % (p=0.49) and 13.24±1.27 and 13.10±1.37 (p=0.50) respectively in both group with duration >5 years and ≤5 years. On the basis of vascular complications, HbA1C, MPV and Duration of DM were (in both group with and without complications respectively), 8.58±0.01 % and 8.56±0.09 % (p=0.03), 13.12±1.40 fl and 12.80±1.21fl (p=0.13), 9.11±3.22 years and 2.5±2.2 years (p<0.0001). CONCLUSION: Our results showed significantly higher MPV in diabetic patients with higher HbA1C (poor glycemic control). This indicates that elevated MPV could be either the cause for or due to the effect of the vascular complications. Hence, platelets may play a role and MPV can be used as a simple parameter to assess the vascular events in diabetes.

Dengue Encephalopathy in Hadoti Region: Clinical Presentation, Diagnostic Evaluation, Management and Outcome.

BACKGROUND: Dengue viral infection is common worldwide. Recent studies have shown dengue viral infection causing encephalopathy, with high morbidity and mortality. Dengue encephalopathy patients usually present with altered sensorium, elevated lab parameters and high antibody titres at the time of admission. Dengue infection was very common and virulent in Hadoti region during August to November 2017 and many patients presented with encephalopathy. AIMS: To study the clinical presentation, lab parameters and other diagnostic features, management and outcome of patients of dengue fever with encephalopathy in Hadoti region in August to November 2017. SETTINGS AND DESIGN: The study was done in Govt Medical college Hospital Kota and other multi-speciality hospitals of Kota. Study population comprised of 60 patients presenting with febrile illness and thrombocytopenia, serologically proved to be having Dengue fever. Among these 60 patients, 30 patients had encephalopathy who presented with altered sensorium, seizures or any other neurological symptoms and remaining 30 had no signs and symptoms of encephalopathy. RESULTS: Among 30 patients with encephalopathy and positive serology (NS1/IgM/ IgG), fever and altered sensorium was most common symptom, while amongst patients without encephalopathy fever with chills and generalised bodyache was more common clinical feature. Convulsions and respiratory distress were very common among encephalopathy patients. Out of 30 encephalopathy patients 16 patients (53%) had convulsions, 14 (46%) had respiratory distress, 17(56%) had shock and 3 patients (10%) had hemiplegia. 2 patients also had visual blurring and dysarthria. Mean duration between appearance of fever and altered sensorium was 4.6 (±2.1) days. Most of patients with encephalopathy had deranged hepatic (bilirubin, SGOT, SGPT), renal (urea, creatinine, decreased urine output) and coagulation parameters (PT/INR, bleeding manifestations). 9 (30%) patients died and 21(70%) patients improved with complete recovery (except 3 hemiplegic patients). CONCLUSION: Increased incidence of dengue fever with encephalopathy in the recent years, in the absence of single sensitive test for detecting dengue encephalopathy, variable CSF and MRI Brain features, and associated high morbidity and mortality poses a big problem for clinician. This study may be helpful in focussing on early diagnosis and aggressive initial management which can influence final outcome.