Evaluation of Pulmonary Functions in Patients With Type 2 Diabetes Mellitus: A Cross-Sectional Study.

Introduction Diabetes mellitus (DM) has been broadly recognized as the syndrome of hyperglycemia leading to various macro- and microvascular complications. The different physiological systems that have been identified as a target of these injurious effects of hyperglycemia are the excretory system, ocular system, central nervous system, and cardiovascular system. To date, not much focus has been given to the respiratory system as a possible target for the deleterious effect of hyperglycemia. Objective To assess the pulmonary functions in subjects with type 2 diabetes mellitus (T2DM) and compare them with age and sex-matched healthy controls. Methods This study was conducted on one hundred and twenty-five patients with type 2 diabetes mellitus and a comparative number of age and sex-matched non-diabetic individuals (control group) who met the inclusion and exclusion criteria. RMS Helios 401 computerized spirometer was used to assess pulmonary functions. Results The mean age of the control group and type 2 diabetics were 50.96±6.85 and 51.47±8.43 years, respectively. The results of the present study showed significantly lower values of FVC, FEV1, FEF25-75%, and MVV among diabetic subjects as compared to controls (<0.05). Conclusion We found that pulmonary function parameters in diabetic subjects were consistently lower than in healthy controls. This reduction in lung function is probably a chronic complication of type 2 diabetes mellitus.

A smartphone-integrated low-cost, reagent-free, non-destructive dried blood spot-based paper sensor for hematocrit measurement.

The blood hematocrit (Hct) level provides vital information about a person's health. Traditional Hct measurement equipment relies heavily on infrastructure and skilled manpower, limiting its broad implementation in resource-limited contexts. Therefore, we developed a simple, reagent-free, non-destructive, smartphone-integrated paper-based device for Hct measurement by analyzing blood-spreading area on a paper substrate. Blood spreading area was found to be dependent on the Hct value, paper properties, and assay duration. This device was calibrated using a custom-made Python algorithm with 10 µl of blood, which produced a sensitivity of -1.90 ± 0.03 mm2/Hct (%) with a LOD as low as 2.17% Hct. The device linear range (8.8 to 58% Hct) is wide enough to cover the clinically relevant range of blood Hct (%). Furthermore, this Python algorithm was coupled with a user-friendly and clinically beneficial Android application (app) to establish an automated tool for quantitative estimation. Comparing the app performance with the result obtained from the gold standard hematology analyzer using blood from 87 subjects reveals a strong correlation (r = 0.99), an average bias of 0.15 with limits of agreement of -2.5 to 2.79 at 95% CI. The device exhibits an accuracy of 96.85% and acceptable reproducibility, with CV ranging from 0.8 to 7.5%. An integrated detection cum readout guiding pattern may allow this device to be suitable for simultaneous quantitative and qualitative estimation and to be employed in both developed and resource-limited clinical settings for Hct measurement in routine checkups and regular monitoring during critical care, as well as in the initial screening of large anemic populations.

Acute Kidney Injury in COVID-19: Clinical Profile and Outcome.

Introduction: Acute kidney injury (AKI) can be a severe complication of the coronavirus 2019 (COVID-19) infection. Follow-up data of these AKI patients, including the rate of progression to chronic kidney disease (CKD), is limited. Methods: COVID-19 patients with AKI, admitted from June 1, 2020, to August 25, 2020, were enrolled prospectively. Their clinical profile, biochemical investigations, urine analysis, treatment, and outcome in terms of mortality or discharge were analyzed. The discharged patients were followed up 3 months later to determine their renal recovery status. Results: AKI was noted in 146 out of 4,613 COVID-19 patients with an incidence of 3.16%. The outcome was available for 111 patients. According to the KDIGO (Kidney Disease Improving Global Outcomes) AKI criteria, 20 (18%) patients were in Stage 1, 16 (14%) in Stage 2, and 75 (68%) in Stage 3 AKI. Proteinuria and hematuria were present in 66% and 41%, respectively. Renal replacement therapy (RRT) was required in 45 (40.5%) patients. A total of 53 (47.7%) patients turned RT-PCR negative and were discharged. The renal recovery at discharge was complete in 31 of 111 (28%), partial in 20 of 111 (18%), and none in two (2%) patients. At 3 months follow-up of discharged patients, total mortality rate was 55.85%. Twenty three of 53 (43%) recovered their renal functions to baseline and 26 of 53 (49%) had progressed to CKD. Diabetes mellitus, dyspnea, altered sensorium, severe acute respiratory distress syndrome, need for RRT, lymphopenia, high neutrophil-lymphocyte ratio, hyperglycemia, raised inflammatory markers, and hematuria were associated with high mortality rate and reached statistical significance. Conclusion: AKI in COVID-19 patients has a high mortality rate (55.85%) with a high CKD progression rate among survivors (49%).

A Unified Citywide Dashboard for Allocation and Scheduling Dialysis for COVID-19 Patients on Maintenance Hemodialysis.

Introduction: The coronavirus disease 2019 (COVID-19) pandemic has caused significant global disruption, especially for chronic care like hemodialysis treatments. Approximately 10,000 end-stage kidney disease (ESKD) patients are receiving maintenance hemodialysis (MHD) at 174 dialysis centers in Greater Mumbai. Because of the fear of transmission of infection and inability to isolate patients in dialysis centers, chronic hemodialysis care was disrupted for COVID-19-infected patients. Hence, we embarked on a citywide initiative to ensure uninterrupted dialysis for these patients. Materials and Methods: The Municipal Corporation of Greater Mumbai (MCGM) designated 23 hemodialysis facilities as COVID-positive centers, two as COVID-suspect centers, and the rest continued as COVID-negative centers to avoid transmission of infection and continuation of chronic hemodialysis treatment. Nephrologists and engineers of the city developed a web-based-portal so that information about the availability of dialysis slots for COVID-infected patients was easily available in real time to all those providing care to chronic hemodialysis patients. Results: The portal became operational on May 20, 2020, and as of December 31, 2020, has enrolled 1,418 COVID-positive ESKD patients. This initiative has helped 97% of enrolled COVID-infected ESKD patients to secure a dialysis slot within 48 hours. The portal also tracked outcomes and as of December 31, 2020, 370 (27%) patients died, 960 patients recovered, and 88 patients still had an active infection. Conclusions: The portal aided the timely and smooth transfer of COVID-19-positive ESKD patients to designated facilities, thus averting mortality arising from delayed or denied dialysis. Additionally, the portal also documented the natural history of the COVID-19 pandemic in the city and provided information on the overall incidence and outcomes. This aided the city administration in the projected resource needs to handle the pandemic.

Effect of Nasal Dominance on Pulmonary Function Test and Heart Rate: A Pilot Study.

BACKGROUND: The nasal cycle is one of the many cyclic events in a human being. Nasal airflow is greater in one nostril at any given point in time and this alternates between right and left nostrils over time. Its periodicity ranges from 25 min to 8 h. This alteration has been known to be controlled by the autonomic nervous system. The current study was designed to assess the effect of nasal dominance during rest on pulmonary function parameters and heart rate. MATERIALS AND METHODS: A cross-sectional study was done on 35 apparently healthy individuals of the age group of 18-30 years. Based on a cold mirror test, the participants were categorized into two groups of right nasal dominance (RND) and left nasal dominance (LND). The parameters recorded were forced expiratory volume in the first sec (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow rate, forced expiratory flow between 25%-75%, SpO2, and pulse rate. Data were expressed as mean ± standard deviation and were analyzed using SPSS version 20. RESULTS: All pulmonary function parameters exhibited higher values in RND participants compared to LND participants and the difference was found to be statistically significant (P < 0.05). CONCLUSION: Nasal dominance has a measurable effect on pulmonary functions and heart rate hence emphasizing the role of autonomic control of airways. This influence can be used as adjuvant therapy for certain disorders.

Parkinson's Disease and the COVID-19 Pandemic: A Review Article on the Association between SARS-CoV-2 and α-Synucleinopathy.

There is an extensive debate on the neurological consequences of 2019 novel coronavirus disease (COVID-19) and its impact on Parkinson's disease (PD) patients, which seems to puzzle neurologists. Links between viral infections and PD have long been suspected and studied, but the exact relationship remains elusive. Since severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) enters the brain through multiple routes and has a direct impact on the brain, cumulative damage occurs due to the activation of proinflammatory cytokines and chemokines. SARS-CoV-2 seems to aggravate PD due to its effects on α-synuclein, mitochondrial dysfunction, and dopamine depletion. A few studies have even highlighted the higher vulnerability of PD patients to COVID-19. The sudden dramatic change in lifestyle caused by the pandemic and the widespread lockdowns that were implemented have added to the hidden sorrows of PD patients, as they already have a compromised mechanism for coping with stress. This review summarizes insights from basic science and the clinical effect of SARS-CoV-2 infection on the human brain, with a specific focus on PD.

Clinical Profile and Outcome of Hemodialysis Patients with SARS COV2 Infection in a Tertiary Care Centre in Mumbai, India.

INTRODUCTION: CKD5D is a high risk subgroup with high comorbidity burden, need for frequent visits to dialysis centre and a compromised immune system. The effect of SARS COV2 virus on this population is not well known. METHODS: This prospective study enrolled, all CKD5D with COVID 19 infection, admitted to our hospital, from 23rd April to 30th June 2020 & whose outcome as discharge/mortality was known. Their clinical profile, investigations, treatment and outcome in terms of mortality or discharge after clearing infection was noted and analysed. RESULTS: Total 203 dialysis patients with COVID 19 were referred to our institute. Of these total, 131 were analysed. Median age was 50 years (19-80 years) with 57% were males. Hypertension (76%) was the commonest comorbidity followed by diabetes (29%) and coronary artery disease (22%). Dyspnoea, fever and cough were present in 50%, 40%, and 33% patients respectively. 26% were asymptomatic. None had dialyser clotting. Mortality was 20.6%. Time to turn RT PCR negative was 14 days (3-40 days). Comparing deceased vs survivors: Age [56 vs 49 yrs], diabetes [56% vs 22%], duration of symptoms at admission [5 vs 4 days], dyspnea [85% vs 40%] and encephalopathy [30% vs 1%] at admission, bilateral opacities on Chest X ray [93% vs 20%] and high leucocyte count [11,059 ± 5,929 vs 7,022 ± 2,935/cmm] were statistically significant variables associated with mortality. CONCLUSION: Asymptomatic group was 26% of the total CKD5D with COVID 19 infection population analysed. Mortality was 20.61%. Higher age, later presentation to hospital, diabetes, dyspnoea, & encephalopathy at presentation, bilateral opacities on Chest X- Ray & higher leukocyte counts were significantly associated with mortality.

Renal and Hepatic Outcomes after Remdesivir Therapy in Coronavirus Disease-2019-Positive Patients with Renal Dysfunction at Baseline or after Starting Therapy.

We aimed to study the effect of remdesivir therapy on renal and hepatic function in coronavirus disease-2019 (COVID-19) patients with renal dysfunction at baseline or after starting therapy and identify the factors, if any, related to the efficacy of remdesivir therapy on patient outcome. Patients included in the study were those who met all the following criteria irrespective of baseline glomerular filtration rate [including those already on maintenance hemodialysis (HD)] or baseline deranged liver function test. (1) Age >18 years, (2) COVID-19 reverse transcriptase-polymerase chain reaction positive, (3) Meeting criteria for administration of remdesivir - [any one of the following: (a) COVID-19 pneumonia with respiratory rate >30/min or SPO2<94% on room air, (b) Acute respiratory distress syndrome (ARDS)]. (4) Renal dysfunction at baseline, during or within 48 h of completion of therapy. Thirty-four patients had renal dysfunction at baseline or developed it after remdesivir therapy - 16 were acute kidney injury (AKI), 10 chronic kidney diseases (CKD), four CKD stage 5D, and four were postrenal transplant. The overall mortality was 18/34 (52.9%). Eight out of 30 (26.66%) needed HD during or after therapy and of these, 15 died and among 15 survivors, 14 returned to their baseline renal function after cessation of therapy, one patient is still dialysis dependent. In the dialysis-dependent CKD (n = 4) subgroup, three died and one was discharged. In the postrenal transplant (n = 4) group, all developed AKI during or after the completion of therapy. None required HD, two returned to their baseline renal function, and two died. Only five had alanine aminotransferase elevation (×1 upper limit of normal) during or within 48 h of completion of therapy - three died and two returned to baseline. Lower PaO2/FiO2 (severe ARDS) (P = 0.0001), higher C-reactive protein (P = 0.022), higher serum lactate dehydrogenase (P = 0.038), and duration of symptoms before starting therapy (P = 0.05) were statistically significant variables at baseline associated with higher mortality. Remdesivir can be tried in moderate-to-severe COVID-19 cases with renal dysfunction as a complete recovery of renal function was noted in survivors. However, larger and well-controlled studies evaluating its safety and efficacy in patients with AKI and CKD are needed.

Perception and practice of placebo use among physicians in Mangalore.

BACKGROUND: Placebo use falls under two contexts: clinical care and research. In today's pharmacological era where treatment is available for almost all illnesses, there exists a lot of questions about the perceived efficacy and usage of placebos. This study focuses on assessing the knowledge, attitude, and practice of placebo use in clinical medicine. This study also aimed to pay attention to the ethical dimensions of using a placebo in clinical practice. SUBJECTS AND METHODS: A cross-sectional study was conducted among 86 physicians in five hospitals and various private clinics in Mangalore, India, using a self-administered questionnaire. RESULTS: About 72% of physicians were found to be prescribing placebos. Vitamins were the most commonly prescribed placebos. Pure placebos were prescribed by 69.4% and impure placebos by 83.9% of physicians. Pure placebos were deemed acceptable by 70.9% of physicians if used for their psychological effect, but only 46.5% said the same for impure placebos. Placebos were most commonly prescribed to conform to the patients' requests for some sort of medicine. Among our physicians, 54.8% and 62.8% of placebo prescribers felt that many or some patients would be disappointed if they were to find out that they had been treated with pure or impure placebos, respectively. CONCLUSION: Physicians agreed that placebos were acceptable in some circumstances in clinical practice. Physicians think that the information and training about placebos during their medical studies was insufficient. Perhaps, more time should be put into teaching about placebos during medical studies and proper guidelines should be laid down about placebo usage.

Effect of gestational diabetes on the vitamin D levels in the neonates: a case control study.

BACKGROUND AND OBJECTIVES: The present study was conducted to determine the effect of maternal gestational diabetes on the Vitamin D levels of the mother and their newborns and to compare it with healthy mother-infant pairs. METHODS: The study design was a Case Control study. It was conducted at the antenatal unit of Obstetrics and Neonatal unit of Pediatrics department of a tertiary care hospital in costal Karnataka. Consecutive sample of otherwise healthy pregnant women presenting with Gestational Diabetes Mellitus (GDM) and their healthy term neonates were taken as study group. The weight matched healthy mothers and their healthy term neonates were taken as controls. The blood samples of the mothers, at term and the cord blood samples of the neonates were collected for estimating the Vitamin D levels. Vitamin D levels in the cases and controls were the primary outcome measures. RESULTS: The mean value of Vitamin D levels in the GDM mothers was 10.74 ng/ml and in the mothers forming the control group was 23.53ng/ml (p value < 0.001). The mean value of Vitamin D levels in GDM babies was 8.47ng/ml and was 19.51ng/ml in the control (p value < 0.001). CONCLUSION: Comparison of Vitamin D levels of mothers and infants of both groups showed a positive correlation. GDM seems to exacerbate the Vitamin D deficiency in the mothers and their neonates.

Reports of a Conus Cauda Tumor with Holocord Syrinx in an Adolescent Girl.

INTRODUCTION: Spinal cord ependymoma seldom presents with holocord syringomyelia in pediatric age-group. Association of ependymoma with a lipoma is also rare. The child presented critically ill with polymicrobial pneumonia, and the neurologic findings were missed until recovery. We report a case highlighting these findings. CASE REPORT: A 16-year-old adolescent presented critically ill with respiratory failure due to severe pneumonia. Evaluation showed fungal pneumonia with secondary bacterial infection. On recovery, she had nasal regurgitation and required nasogastric tube feeding. Examination showed palatal and left vocal cord palsy. Neuroimaging of brain showed conus cauda tumor with syringobulbia and holocord multiseptate syrinx extending from medulla to filum terminale with lipoma. Histopathology examination showed myxopapillary ependymoma. She improved with excision and postoperative radiotherapy. DISCUSSION: Our case is a rare report of an adolescent girl with conus cauda tumor and holocord syrinx.

Assessment of the Anterior Loop of the Mandibular Canal Using Cone-Beam Computed Tomography in Eastern India: A Record-Based Study.

OBJECTIVE: The aim of this study was to assess the presence and course of the anterior loop (AL) in an Odisha sample population using cone-beam computed tomography (CBCT) and to accurately identify and analyze the length, height, and diameter of AL in male and females. MATERIALS AND METHODS: CBCT images from 1000 patients obtained for various clinical indications were randomly selected and evaluated to determine the presence, length, height, and diameter of the AL. The various parameters were then compared based on gender, age, and the side of the mandible. The data were analyzed using the Chi-square test, independent t-test, multiple post hoc procedure, and one-way ANOVA test. RESULTS: An AL was identified in 9.7% of the cases, and its mean length ranged from 1.8 to 4.8 mm. The loop had a greater mean length and was significantly more prevalent in males. The diameter ranged from 1 to 4 mm and height ranged from 7.8 to 15.1 mm. The AL was most commonly found in the middle-aged patients (39-48 years) which attributed to around 27.83%. CONCLUSION: In this study, a lower prevalence of the AL of the mandibular canal was found. Being an anatomical variation, an exact evaluation of the AL must be established using the imaging techniques prior to any surgical procedure.

Anaphylactic Shock Secondary to Intravenous Iron Sucrose in Chronic Kidney Disease.

Intravenous (IV) iron is an essential component of therapy of anemia of chronic kidney disease (CKD). We present a rare case in which iron sucrose was infused to a patient of CKD and resulted in severe anaphylaxis and cardiac arrest minutes after starting the infusion. He was aggressively resuscitated with adrenaline and other measures following which he recovered. The use of parenteral iron is associated with several adverse drug reactions (ADR) which were seen with preparations like iron dextran but became rare with the use of newer safe preparations like iron sucrose or gluconate. The ADR can be mild or can have severe life threatening features like syncope, cardiac arrhythmias, seizures, bronchospasm and rarely cardio respiratory arrest like in our case. Iron sucrose is generally given as a IV infusion of 100-200 mg over 15-30 min and has a very low rate of ADR even with higher doses or bolus injections. But still necessary precautions and appropriate monitoring must be done in all patients. The patients who are allergic to iron sucrose may be treated with other safer preparations or by desensitisation techniques.