Iron Deficiency Anemia as a Potential Risk Factor for Unprovoked DVT in Young Patients: A Case Series.

Deep vein thrombosis (DVT) is a serious and potentially life-threatening condition due to the occurrence of pulmonary embolism (PEs) in the acute phase. DVT can be provoked or unprovoked. Provoked DVT can be associated with transient or persistent causes. Iron deficiency anemia (IDA) with reactive thrombocytosis can act as a prothrombotic condition. We present two case reports of lower limb DVT which was associated with moderate anemia. Association between IDA and thrombosis has been reviewed.

Role of Ambulatory Glucose Profile in Precision Medicine in Type 2 Diabetes Mellitus.

Assessment of diabetes with daily blood glucose fluctuations including peaks and nadirs forms the crux of the modern management. Use of glycemic variability (GV) as a parameter to assess these fluctuations is emerging. It is important to determine the hyperglycemic and hypoglycemic episodes which are the culprits for increasing glycemic variation. Diabetes mellitus patients follow different clinical trajectories which can be traced by the ambulatory glucose profile (AGP) obtained from flash glucose monitoring system (FGMS). MATERIAL: This comparative observational study enrolled 106 adult (>18 years) type 2 diabetes patients with HbA1c<8%. Patients were divided into two groups (group A & group B) with 53 patients each. Group A included patients on OAD's (oral antidiabetic drug) with insulin and Group B included patients on OAD's without insulin. The patients were put on FGMS for 14 days and their AGP was analysed. Hyperglycemic episodes (level 1- >180 mg/dl, level 2- >250 mg/dl) and hypoglycemic episodes (level 1- 54-70 mg/dl, level 2- <54 mg/dl) were determined between the groups. OBSERVATION: Group A patients had significantly higher (29.99%) total number of hyperglycemic episodes (Level 1+ Level 2) as compared with group B (9.08%) (p <0.0001). Amongst group A, proportion of patients with total number of hyperglycemic episodes was significantly higher in insulin only subgroup (58.11%) followed by insulin +metformin+ 1 OAD (29.14%) & insulin+ metformin (26.82%) (p <0.0001). Amongst group B, total number of hyperglycemic episodes were found to be significantly higher with metformin only subgroup (10.19%) followed by metformin + 1 OAD (9.72%) & metformin + >1 OAD (8.1%) (p<0.0001). Amongst the add on OAD's, sulfonylurea contributed to 61.07% hyperglycemic episodes in group A & 11.63% in group B which was statistically more than DPP-4 inhibitors with 14.91% & 2.84% respectively (p <0.0001). Total number of hypoglycemic episodes seen in group A patients (8.66%) were significantly less as compared with group B (13.27%) (p<0.0001). Sulfonylurea contributed to 7.5% hypoglycemic episodes in group A & 13.2% in group B which was statistically more than DPP-4 inhibitors with 6.49% & 12.35% respectively when added to metformin (p<0.0001). CONCLUSION: Amongst the OAD's used in type 2 diabetes mellitus patients in this study, total number of hyperglycemic and hypoglycemic episodes were found to be more in patients taking sulfonylurea as compared with DPP4 inhibitors when used in combination with metformin with or without insulin.

Post-COVID Interstitial Lung Disease - The Looming Epidemic.

INTRODUCTION: As India recovers from the two waves of the Covid-19 pandemic, its sequelae are posing a new challenge to the physician. These may vary from fatigue and myalgia to persistent, and even worsening breathlessness, due to pulmonary fibrosis. Management of post-COVID-19 pulmonary fibrosis is currently limited to symptomatic management and largely an unexplored aspect. OBJECTIVES: To draw attention to the imminent threat of post-COVID-19 interstitial lung disease (PC-ILD) in COVID survivors through a case series. METHODS: A retrospective analysis of data was done in patients admitted with severe COVID in December 2020 at our tertiary care hospital, and who had a prolonged stay with symptoms and signs suggestive of pulmonary fibrosis. HRCT was done to make a diagnosis of pulmonary fibrosis or ILD. Three such patients were identified. RESULTS: All the three cases were laboratory proven SARS CoV-2 positive cases and had developed pulmonary fibrosis, with traction bronchiectasis, termed here as PC-ILD (Post Covid-Interstitial Lung Disease). Two of them survived and had improved oxygen saturation on room air at three-month follow-up, while one patient had developed arrhythmia and died. CONCLUSION: PC- ILD is one of the emerging complications of COVID-19 pneumonia. A proactive follow-up programme should be undertaken to identify and manage this looming epidemic.

COVID-19 and Tuberculosis: A Meeting of Two Pandemics!

Coronavirus disease 2019 (COVID-19), causes serious respiratory illness manifesting as pneumonia, adult respiratory distress syndrome and respiratory failure. Amidst the rising number of cases and deaths, it is imperative to not forget Tuberculosis (TB) which is another pandemic existing since centuries. There could be dire consequences for tuberculosis patients globally especially in low and middle income countries with a high burden of disease and overwhelmed health care systems. Tuberculosis is still the leading infectious killer worldwide, and therefore, it is crucial to reflect on the interaction between the two diseases. Evidence suggests that both COVID-19 and tuberculosis have a synergistic relationship, boosting detrimental effect of each other, disrupting existing health care models, and also worsening the clinical outcomes in terms of morbidity and mortality. This review aims to draw attention towards this pertinent clinical issue, and tries to unravel the intricate relationship between COVID-19 and tuberculosis, as also the role of BCG vaccination to combat the COVID-19 pandemic.

Laparoscopic splenic pseudocyst management using indocyanine green dye: An adjunct tool for better surgical outcome.

Splenic cysts are not so common in incidence. Only 800-850 cases have been reported till now in the literature. Splenic cysts can be further classified into parasitic and non-parasitic cysts. Non-parasitic cyst is further subdivided into true and false or pseudocyst. Pseudocysts are those who are lacking any epithelial lining. Splenic pseudocysts are usually a result of trauma, infection or infarction. We present a case of splenic pseudocyst that was diagnosed incidentally on routine check-up, and we managed this case with minimally invasive approach with complete preservation of spleen and only removal of pseudocyst. We used indocyanine green dye that helped us in complete delineation of splenic parenchyma and vascular structure adjacent to it. In our view, as in this study also, adopting a new technique that can be helpful in better treatment of the patient and if it can change the surgical outcome of the disease in favour of the patient, it should be encouraged.

A rare case of abdominal cocoon caused by brucellosis.

Brucella is the most common zoonosis in the world and is also included among the neglected endemic zoonoses by the World Health Organization. Its clinical presentation is often vague and it is not frequently suspected. A thorough history of social-economic status and animal exposure is often missed. We present a case of abdominal cocoon in a young patient residing at a dairy farm who tested positive for Brucella serology. Timely diagnosis and management prevented the progression of this debilitating condition to intestinal obstruction.

A case of Weil's disease presenting as Stevens-Johnson syndrome.

Leptospirosis presents in a biphasic manner: an early leptospiraemic phase and a late immune phase. In its severe form, it presents with multi-organ failure, also known as Weil's disease. Stevens-Johnson syndrome (SJS) is an autoimmune hypersensitive reaction leading to diffuse fluid filled vesicle formation with detachment of skin and mucous membrane. Though SJS is triggered by different infections and drugs, its association with leptospirosis is not frequently reported. Here we present such a case.

A cross-sectional evaluation of communication skills and perceived barriers among the resident doctors at a tertiary care center in India.

BACKGROUND: The study was conducted to assess the different components of communication skills and barriers to practicing good communication skills among resident doctors in a health care setting. MATERIALS AND METHODS: A web-based cross-sectional survey was performed, and data were collected using a pre-validated questionnaire with a Cronbach's alpha (0.88). A total of 431 responses were statistically analyzed. Chi-square test was used to associate the socio-demographics and communication skills. Regression analysis was conducted to analyze the association between various communication domains and barriers, which were adjusted for potential confounders such as age and gender. RESULTS: Resident doctors have differential levels of competencies in each domain of communication skills. Around two-thirds of the residents did not practice good communication skills while breaking the bad news and reported poor para-verbal skills. Some of the most common barriers to practicing good communication skills were found to be an infrastructural deficit, lack of time, and long working hours. These barriers significantly affected the communication skills such as para-verbal skills {[-0.32; P < 0.01; C.I (-0.54 to -0.09), [-0.27, P < 0.05, C.I (-0.54 to. 004)], [-0.32, P < 0.01, (0.07-0.56)]}, the ability to break bad news {[-0.42, P < 0.01, (-0.73 to -0.11)], [-0.35, P < 0.05, (-0.75 to -0.35)], [0.48, P < 0.01, (0.12-0.84)]}, and communication with patients/attendants {[0.39, P < 0.01, C.I (-0.71 to -0.06)], [-0.88, P < 0.001, C.I (-1.2 to -0.48)], [-0.88, P < 0.001, C.I (-1.2 to -0.48)]} after adjustment for confounding such as age and gender. CONCLUSION: There is a scope for improvement in practicing good communication skills with patients, among the residents doctors in India. Structured modules for training and evaluation should be implemented in the medical curriculum.

Isolation and characterization of resistance gene analogues from Psilanthus species that represent wild relatives of cultivated coffee endemic to India.

Biotic or abiotic stress can cause considerable damage to crop plants that can be managed by building disease resistance in the cultivated gene pool through breeding for disease resistance genes (R-genes). R-genes, conferring resistance to diverse pathogens or pests share a high level of similarity at the DNA and protein levels in different plant species. This property of R-genes has been successfully employed to isolate putative resistance gene analogues (RGAs) using a PCR-based approach from new plant sources. Using a similar approach, in the present study, we have successfully amplified putative RGAs having nucleotide-binding-site leucine-rich repeats (NBS-LRR-type RGAs) from seven different sources: two cultivated coffee species (Coffea arabica L. and Coffea canephora Pierre ex. A. Froehner), four related taxa endemic to India (wild tree coffee species: Psilanthus bengalensis (Roem. & Schuttles) J.-F. Leroy, Psilanthus khasiana , Psilanthus travencorensis (Wight & Arn.) J.-F. Leroy, Psilanthus weightiana (Wall. ex Wight & Arn.) J.-F. Leroy), and a cDNA pool originally prepared from light- and drought-stressed Coffea arabica L. leaves. The total PCR amplicons obtained using NBS-LRR-specific primers from each source were cloned and transformed to construct seven independent libraries, from which 434 randomly picked clones were sequenced. In silico analysis of the sequenced clones revealed 27 sequences that contained characteristic RGA motifs, of which 24 had complete uninterrupted open reading frames. Comparisons of these with published RGAs showed several of these to be novel RGA sequences. Interestingly, most of such novel RGAs belonged to the related wild Psilanthus species. The data thus suggest the potential of the secondary gene pool as possible untapped donors of resistance genes to the present day cultivated species of coffee.

Measles in immunized medical residents: Case series with brief review.

Measles is a vaccine-preventable disease that continues to be a major cause of morbidity and mortality in children and young adults across the world. Immunization efforts have reduced the incidence of measles over the last 3 decades, but outbreaks are seen in high-transmission areas with susceptible populations, as is seen in hospitals and student campuses. The protection offered by prior vaccination may wean off over time making vaccinated individuals susceptible to infection. Hence, catch-up immunization drives should be undertaken for vulnerable populations such as healthcare personnel, along with routine immunization programs, with the goal to eliminate measles in the future. This case series presents measles in two of our medical residents who got infected despite being vaccinated in childhood.

Genetic heterogeneity in wild isolates of cellular slime mold social groups.

This study addresses the issues of spatial distribution, dispersal, and genetic heterogeneity in social groups of the cellular slime molds (CSMs). The CSMs are soil amoebae with an unusual life cycle that consists of alternating solitary and social phases. Because the social phase involves division of labor with what appears to be an extreme form of "altruism", the CSMs raise interesting evolutionary questions regarding the origin and maintenance of sociality. Knowledge of the genetic structure of social groups in the wild is necessary for answering these questions. We confirm that CSMs are widespread in undisturbed forest soil from South India. They are dispersed over long distances via the dung of a variety of large mammals. Consistent with this mode of dispersal, most social groups in the two species examined for detailed study, Dictyostelium giganteum and Dictyostelium purpureum, are multi-clonal.

Serum Vitamin D Level in Patients with Coronary Artery Disease and Association with Sun Exposure: Experience from a Tertiary Care, Teaching Hospital in India.

BACKGROUND: Vitamin D, a fat-soluble vitamin, has various extraskeletal effects, and several human and animal studies have suggested that vitamin D deficiency may be a contributory factor in the pathogenesis of coronary artery disease (CAD). However, such studies in the Indian subcontinent are either lacking or have shown conflicting results. METHODS: This was a descriptive cross-sectional study involving 121 patients with CAD from a tertiary care center and their 80 age-matched healthy controls. Serum vitamin D levels along with serum and urine chemistries were measured in both the groups. The average duration of sun exposure/day and use of sunscreen were also considered in the study cohort using a questionnaire. Serum vitamin D levels were categorized into deficient (<30 nmol/lit), insufficient (30-75 nmol/lit), and sufficient (>75 nmol/lit) groups. RESULTS: Among the cases, 51.2% of the patients were vitamin D deficient and 44.6% patients had insufficient vitamin D levels, whereas among controls, 40% and 31% of the population had deficient and insufficient levels of vitamin D, respectively. However, the mean value of the serum vitamin D level was not statistically different in the cases as compared to that of the controls (34.06 vs 40.19 nmol/lit) (P=0.08). Corrected serum calcium (9.26 vs 9.59 mg%) (P ≤ 0.0001) and serum albumin levels (4.21 vs 4.75 gm%) (P ≤ 0.0001) were lower in the cases than those of the controls. The average sun exposure/day was higher among the cases than that among the controls (2.93 vs 1.85 hours) (P=0.001). CONCLUSION: Vitamin D deficiency is widely prevalent in Indian population despite abundant sunshine, and the duration of sun exposure is not correlated with serum vitamin D levels. Vitamin D deficiency is not associated with CAD. However, serum calcium is deficient in CAD patients as compared to the controls. Large-scale studies are required to explore the association further to evaluate the benefits of screening and correction of vitamin D deficiency in patients with CAD.

Multiple alternative splicing of Dmrt1 during gonadogenesis in Indian mugger, a species exhibiting temperature-dependent sex determination.

Dmrt1 is an evolutionarily conserved gene having important role in the sex determination from lower vertebrates to mammals. Recent studies show transcriptional diversity for this important gene during gonadal differentiation in a few vertebrate species having genetic sex determination (GSD). In this study, we show for the first time that the transcriptional diversity of Dmrt1 is also found in the Indian mugger that exhibits temperature-dependent sex determination (TSD). We report here isolation and characterization of eight novel isoforms of Dmrt1 from Crocodylus palustris, along with its genomic locus that is referred as, cpDmrt1. Further, by sequence comparisons of cpDmrt1 and its expressed isoforms, we demonstrate that all the isoforms are generated by alternative splicing, exonization of intronic sequences and alternative polyA sites from the same locus. The eight transcripts range from 494 to 2060 bp and encode six predicted proteins having the characteristic DM domain of Dmrt1. The major heterogeneity in the isoforms and their predicted proteins is seen only in their C-termini and 3'-UTRs, which do not match with any similar sequences reported for other vertebrates. The cpDmrt1 expression was seen mainly in developing GAM (genital ridge-adrenal-mesonephros complex) with significant upregulation only in male embryos from the start of the temperature sensitive period (TSP). More significantly, approximately 70% of this expression was contributed by only one isoform (cpDmrt1e) that also has a unique 15 amino acid domain towards its C-terminal. cpDmrt1 expression was also detected at a lower level in brain and developing kidney. The study thus provides the first account of Dmrt1 locus, its transcriptional diversity and sex-specific expression in Indian mugger, a TSD species.

Development of new genomic microsatellite markers from robusta coffee (Coffea canephora Pierre ex A. Froehner) showing broad cross-species transferability and utility in genetic studies.

BACKGROUND: Species-specific microsatellite markers are desirable for genetic studies and to harness the potential of MAS-based breeding for genetic improvement. Limited availability of such markers for coffee, one of the most important beverage tree crops, warrants newer efforts to develop additional microsatellite markers that can be effectively deployed in genetic analysis and coffee improvement programs. The present study aimed to develop new coffee-specific SSR markers and validate their utility in analysis of genetic diversity, individualization, linkage mapping, and transferability for use in other related taxa. RESULTS: A small-insert partial genomic library of Coffea canephora, was probed for various SSR motifs following conventional approach of Southern hybridisation. Characterization of repeat positive clones revealed a very high abundance of DNRs (1/15 Kb) over TNRs (1/406 kb). The relative frequencies of different DNRs were found as AT >> AG > AC, whereas among TNRs, AGC was the most abundant repeat. The SSR positive sequences were used to design 58 primer pairs of which 44 pairs could be validated as single locus markers using a panel of arabica and robusta genotypes. The analysis revealed an average of 3.3 and 3.78 alleles and 0.49 and 0.62 PIC per marker for the tested arabicas and robustas, respectively. It also revealed a high cumulative PI over all the markers using both sib-based (10-6 and 10-12 for arabicas and robustas respectively) and unbiased corrected estimates (10-20 and 10-43 for arabicas and robustas respectively). The markers were tested for Hardy-Weinberg equilibrium, linkage dis-equilibrium, and were successfully used to ascertain generic diversity/affinities in the tested germplasm (cultivated as well as species). Nine markers could be mapped on robusta linkage map. Importantly, the markers showed ~92% transferability across related species/genera of coffee. CONCLUSION: The conventional approach of genomic library was successfully employed although with low efficiency to develop a set of 44 new genomic microsatellite markers of coffee. The characterization/validation of new markers demonstrated them to be highly informative, and useful for genetic studies namely, genetic diversity in coffee germplasm, individualization/bar-coding for germplasm protection, linkage mapping, taxonomic studies, and use as conserved orthologous sets across secondary genepool of coffee. Further, the relative frequency and distribution of different SSR motifs in coffee genome indicated coffee genome to be relatively poor in microsatellites compared to other plant species.

A new frog species from the central western Ghats of India, and its phylogenetic position.

Tropical evergreen forests of Indian subcontinent, especially of the Western Ghats, are known hot spots of amphibian diversity, where many new anuran species await to be identified. Here we describe from the Sharavathi River basin of central Western Ghats a new shrub-frog taxon related to the anuran family Rhacophoridae. The new frog possesses the characteristic features of rhacophorids (dilated digit tips with differentiated pads circumscribed by a complete groove, intercalary cartilages on digits, T-shaped terminal phalanges and granular belly, the adaptive characters for arboreal life forms), but also a suite of unique features that distinguish it from all known congeners in the region. Morphogenetic analysis based on morphological characteristics and diversity in the mitochondrial 12S and 16S rRNA genes revealed it to be a new Philautus species that we named Philautus neelanethrus sp. nov. The phylogenetic analysis suggests the new frog to represent a relatively early Philautus species lineage recorded from the region. The distribution pattern of the species suggests its importance as a bioindicator of habitat health. In general, this relatively widespread species was found distributed only in non-overlapping small stretches, which indirectly indicates the fragmentation of the evergreen to moist deciduous forests that characterize the Western Ghats. Thus the discovery of the new rhacophorid species described here not only further reinforces the significance of the Western Ghats as a major hotspot of amphibian biodiversity, but also brings into focus the deterioration of forest habitats in the region and the need for prioritization of their conservation.

Coronary artery disease and its association with Vitamin D deficiency.

Coronary artery disease (CAD) has become the latest scourge of humankind and referred to in this article as CAD, is the end result of the accumulation of atheromatous plaques within the walls of coronary arteries that supply the myocardium, a process also known as atherosclerosis and manifests mostly in the form of chronic stable angina or acute coronary syndrome. Vitamin D has attracted considerable interest recently due to its role in a number of extraskeletal disease processes including multiple sclerosis, malignancies, diabetes mellitus, and CAD. It is also known as sunshine vitamin due to its production in the body following exposure to ultraviolet rays, and it is a unique vitamin as it acts like a hormone with its receptor present in a wide range of tissues including endothelium, which is the important mediator of atherosclerosis and subsequent CAD. A large number of studies conducted in the past have provided the basic scientific framework and this article attempts to explore the role of Vitamin D deficiency in the pathogenesis of CAD and stresses the need for further research to fill up gap in our knowledge.

Draft Genome Sequence of a Versatile Hydrocarbon-Degrading Bacterium, Rhodococcus pyridinivorans Strain KG-16, Collected from Oil Fields in India.

We describe here a 5.8-Mb draft genome sequence of Rhodococcus pyridinivorans strain KG-16, which was obtained from the soil samples collected from the oilfields of Krishna-Godavari basin in India. This genomic resource can provide insights into the pathways and mechanisms of hydrocarbon degradation and potentially aid in bioremediation applications.