Assessment of Lung Functions by Spirometry in Diabetics with no Respiratory Complaints.

BACKGROUND AND OBJECTIVES: Diabetes produces a number of biochemical, morphological, and functional abnormalities that can affect the kidney, cardiovascular and neurological systems, as well as the skin and liver by altering collagen and elastic fibers. Diabetics' lungs show histological alterations such as thicker alveolar epithelium and pulmonary capillary basal lamina, resulting in decreased pulmonary elastic rebound and lung volume. Spirometry is a test to assess lung function in various respiratory diseases. The aim of our study was to assess the lung function by spirometry in patients with diabetes mellitus with no respiratory complaints and compare with lung function among healthy controls. Our additional intention was to find out the association between duration of disease and lung function impairment, if any, and further to compare impairment in lung function, if any, between diabetic patients with controlled and uncontrolled glycemic status. We also compared lung function between diabetic patient with diabetic complications and diabetic patient without diabetic complications. MATERIAL AND METHODOLOGY: This cross-sectional observational study was conducted in Department of Medicine. Patients attending the Medicine OPD for Diabetes Mellitus with no respiratory complaints were interviewed. After application of appropriate inclusion and exclusion criteria, qualifying subjects underwent detailed history, clinical examination, routine investigations and spirometric evaluation. A total of thirty cases were included in the study. A total of thirty age and sex matched apparently healthy subjects were also taken as controls. OBSERVATION AND RESULTS: In our study, FEV1 (Measured Value) was normally distributed and, therefore, student t-test (2 tailed) was used to analyze the difference between the groups. No statistically significant difference was found between the cases and controls (p value = 0.437). FVC was also normally distributed and, therefore, student t-test (2 tailed) was used to analyze the groups. No statistically significant difference was found between the cases and controls (p value = 0.331). FEV1/FVC Ratio (Measured) was not normally distributed and therefore a non parametric test was used to analyze the groups. No statistically significant difference was found between the cases and controls (p value 0.336). The Mean ± SD of FEV1 (Measured Value) was 2.55 ± 0.66 for the diabetic subjects with duration 0- 5 Years, 2.21 ± 0.69 for those with duration 6-10 Years and 2.53 ± 0.67 for those with duration >10 years. No statistically significant difference was found between the three groups (p value 0.433) as assessed by One way ANNOVA. The Mean ± SD of FVC (Measured Value) was 3.19 ± 0.82 for diabetics with duration 0- 5 Years, 2.79 ± 0.81 for those with duration 6-10 Years and 3.29 ± 0.93 for those with duration >10 years. Again, no statistically significant difference was found between the 3 groups (p value 0.523) as assessed by One way ANNOVA. The Mean ± SD of the FEV1/FVC (Measured Value) was 0.8 ± 0.05 for the subjects with diabetes duration 0- 5 Years, 0.79 ± 0.07 for those with duration 6-10 Years and 0.78 ± 0.04 for those with duration >10 years. No statistically significant difference was found between the 3 groups (p value 0.563). On basis of spirometry interpretation out of 30 cases, 2 patients (6.67%) were found to have a restrictive pattern of airway disease. On other hand, all controls were found to have a normal pattern of spirometry. No statistically significant difference between spirometric parameters of FEV1, FVC, FEV1/FVC, FEF25-75% was found between diabetic subjects with and without complications abd among diabetics with controlled and uncontrolled diabetes. CONCLUSION: This study shows that spirometric variables FEV1, FVC, FEV1/FVC and FEF 25-75% were not different between diabetic subjects who were not having respiratory complaints and healthy controls. Also, duration of diabetes, diabetic control and presence of other diabetes related complications do not affect the lung function among diabetics. So, unlike eye and kidney, there is no need for screening for lung function abnormality among diabetics with no respiratory complaints.

Secondary Hypertriglyceridemia Causing Recurrent Acute Pancreatitis with Normal Pancreatic Enzymes.

Hypertriglyceridemia (HTG) is the third leading cause of acute pancreatitis (APs) worldwide which is invariably associated with elevated pancreatic enzyme levels. We present a case of HTG-induced recurrent AP with normal serum amylase and lipase levels in a patient of Syndrome Z.

Diagnostic and Prognostic Role of Neutrophil-to-Lymphocyte Ratio in Early and Late Phase of Sepsis.

OBJECTIVE: Early diagnosis of sepsis is necessary to decrease morbidity and mortality. This study aims to evaluate neutrophil-to-lymphocyte ratio (NLR) as diagnostic and prognostic of early and late phase of sepsis. METHODS: It was a prospective, observational study, conducted in Intensive Care and High Dependency Unit (Daycare) of the Department of Pulmonary and Critical Care Medicine (tertiary care center), Rohtak, from January 2017 to December 2017. A total of 56 cases of newly diagnosed cases of sepsis were included in the study and 20 healthy adults were taken as controls. Daily NLR was calculated in cases till the primary outcome. RESULTS: The results suggested that NLR seems to have promising role as diagnostic and prognostic marker (with P = 0.001 and P = 0.045, respectively) in sepsis. CONCLUSION: The study suggests that NLR can be a useful diagnostic and prognostic marker in sepsis.

Post COVID-19 syndrome and new onset diseases: A prospective observational study.

Introduction: The National Institute of Health and Care Excellence (NICE) has defined the terms, 'acute coronavirus disease 2019' (COVID-19), 'ongoing symptomatic COVID-19' and 'post-COVID-19 syndrome', with the latter two described as having persistent symptoms after the onset of COVID-19 symptoms for 4-12 weeks and >12 weeks, respectively. Persistent symptoms can either be due to the after-effects of COVID-19 or new-onset diseases after acute COVID-19. All symptoms observed beyond 4 weeks after the onset of COVID-19 need not be present at the time of onset. Previous studies on persistent post-COVID-19 symptoms have not mentioned new-onset diseases after acute COVID-19, and only a select few studies have discussed such new-onset symptoms. Methods: Ninety-five patients who attended the post-COVID-19 clinic completed the requisite follow-up till 16 weeks after COVID-19 symptom onset. Data was recorded on a predesigned proforma. Necessary investigations were conducted to rule out any other cause of persistent symptoms. Results: Fatigue (62.1%), breathlessness (50.5%) and cough (27.4%) were the most common symptoms present beyond 4 weeks after the onset of COVID-19 symptoms. Forty-nine (51.57%) patients developed post-COVID-19 syndrome - their severity of symptoms (odds ratio [OR] 17.77) and longer duration of hospital stay (OR 1.095) during acute disease were significantly associated with the development of post-COVID-19 syndrome. During follow-up, 25 patients developed new-onset symptoms, such as diabetes mellitus, hypertension and idiopathic tachycardia. Conclusion: Patients can have persistent symptoms, new-onset symptoms and new-onset diseases after recovery from acute COVID-19.

Reconditioned monocytes are immunomodulatory and regulate inflammatory environment in sepsis.

Sepsis is caused by dysregulated immune response to severe infection and hyper inflammation plays a central role in worsening the disease. The immunomodulatory properties of mesenchymal stem cells (MSCs) have been evaluated as a therapeutic candidate for sepsis. Reconditioned monocytes (RM), generated from healthy human peripheral blood mononuclear cells (PBMCs) exhibit both macrophage and MSCs-like properties. RM were administered at different stages of sepsis in a mouse model. It reduced serum levels of IL6, MCP-1, IL-10, improved hypothermia, increased survival, and recovery from 0 to 66% when combined with antibiotics in the mouse model. The reduced human leucocyte antigen DR molecules expression on RM enables their co-culture with PBMCs of sepsis patients which resulted in reduced ROS production, and up-regulated TGF-ß while down-regulating IL6, IL8, and IL-10 in-vitro. RM are potentially immunomodulatory, enhance survival in sepsis mouse model and modulate inflammatory behaviour of sepsis patient's PBMCs.

Tracing Historical Forms of Servitude: Introductory Remarks and Elementary Reflections.

History of domestic service in South Asia is beginning to attract scholars but a rich historiography around it is still distant and difficult. The forms of servitude are different across different times, places and contexts. The sources available to scholars for specific sites and moments in history are marked by extreme diversity of language, genre, concerns, and vantage points. Studies based on exploration of particular kinds of texts across dissimilar contexts make for a good beginning. Using insights from apparently disjointed explorations of servitude in uneven locales, we sketch a tentative template to study changing patterns of service relations and their articulations in the long duration beginning with the early modern period and reaching up to our own times. The study of domestic service yields empathetic vignettes of lives of domestic servants. They also yield insights on various forms of servitude and their centrality to social and economic relationships in a manner that can potentially upset the set historiographic paradigms of work, leisure, household, labour and 'labour laws' in the early modern and modern periods.

A rare case of reversible acquired AA-type renal amyloidosis in a chronic filariasis patient receiving antifilarial therapy.

Lymphatic filariasis is a major health problem in India with a large number of patients tending to be asymptomatic. In the Southeast and South Asian regions, Wuchereria bancrofti is the most prevalent parasite, causing filariasis in 99.4% of cases. While kidney involvement is a rare event in chronic filariasis, this case is unique because AA-type renal amyloidosis occurs in chronic W. bancrofti infection. We present here a unique case of lymphatic filariasis. The patient, a 25-year-old male who was previously diagnosed with right lower limb filarial lymphedema and had undergone lymphovenous anastomosis, was admitted for evaluation of persistent nephrotic-range proteinuria. Autoimmune markers in the form of anti-nuclear antibodies, anti-double-stranded DNA and anti-neutrophil cytoplasmic antibody were negative; C3 was normal. Urine analysis revealed inactive sediment with moderate proteinuria. Both serum and urine electrophoresis were negative for paraproteins and bone marrow aspirate and biopsy were normal. Evidence of active filarial infection was established on the basis of microfilariae in the peripheral smear and a positive W. bancrofti antigen test. Kidney biopsy revealed renal amyloidosis when stained with Congo red and anti-AA immunostain. The patient's proteinuria improved on conservative management with angiotensin-converting enzyme inhibitors and a course of antifilarial drugs. His proteinuria returned to <1 g/24 h with normalization of renal function and no significant proteinuria on periodic follow-up at 6-month and 1-year intervals. Repeat kidney biopsy after 1.5 years showed regression of amyloidosis. Repeat demonstration of filarial antigen and microfilariae in the peripheral smear were negative on multiple occasions during the follow-up period. Although various chronic infections can lead to secondary renal amyloidosis, this is the first case reported in world literature where secondary amyloidosis developed as a complication of chronic filarial infection due to W. bancrofti. This is probably also the first case reported in world literature where renal amyloidosis has an etiological association with W. bancrofti infection and where patient symptoms improved with antifilarial and antiproteinuric management.

Aneurysmal bone cyst of the ethmoid sinus: A case report.

BACKGROUND: Aneurysmal bone cyst is an expansile bone lesion, non-neoplastic in nature, occurring most commonly in long bones. It is uncommon in facial bones and exceptionally rare in ethmoid bone. Ten cases of aneurysmal bone cysts of ethmoid bone have been reported so far. CASE REPORT: A young adolescent presented with decreased vision and pain in the right eye. MRI revealed an expansile lesion having conspicuous fluid levels with a multiloculated appearance in the right ethmoid bone extending to the right orbit. CT was done to characterize better bone details. Both biopsy of the lesion and histopathology of resected specimen confirmed aneurysmal bone cyst. CONCLUSIONS: A characteristic appearance on MRI and CT examinations helped to confidently diagnose a relatively common lesion in an exceedingly rare location.

Human immunodeficiency virus encephalitis.

Here, we present a case of pyrexia with altered sensorium in a young healthy male individual. On evaluation, he was detected to have human immunodeficiency virus infection with low CD4. He had no opportunistic infection or any other acquired immunodeficiency syndrome-defining illnesses although his magnetic resonance imaging brain showed features of encephalitis. He recovered tremendously within 3 months of antiretroviral therapy.

Clinical and laboratory factors associated with mortality in dengue.

Dengue is endemic in more than 100 countries, giving rise to an increased number of deaths in the last five years in the South-East Asian region. We report our findings from a retrospective study of adults admitted with confirmed dengue at our institution. We studied the clinical and laboratory parameters associated with mortality in these patients. Of the 172 hospitalised patients studied, 156 (90.69 %) recovered while 16 (9.3%) died. Univariate analysis showed altered sensorium on presentation, lower haemoglobin and haematocrit levels, higher serum creatinine, higher serum transaminase and lower serum albumin levels to be significantly associated with mortality in dengue. Further, using stepwise multivariate logistic regression, altered sensorium ( P = 0.006) and hypoalbuminemia ( P = 0.013) were identified as independent predictors of mortality in dengue. Identification of these parameters early in the course of disease should prompt intensification of treatment in dengue cases.

Anaplastic large T-cell lymphoma presenting as an isolated osseous involvement: a case report and review of the literature.

This case describes a 50-year-old man with multiple lytic bone lesions involving the skull, pelvis and ribs and associated features of anaemia, hypercalcaemia, azotaemia and subsequently found to be non-Hodgkin's lymphoma of anaplastic large T cell type (ALCL) on biopsy taken from a soft tissue mass in the anterior chest wall as an aetiology. We report this case with an aim to expand our knowledge of isolated osseous involvement in case of non-Hodgkin's lymphoma. This case was unique in the sense of an isolated osseous involvement in ALCL without any organomegaly and lymphadenopathy with a normal bone marrow biopsy finding. So in rare instances, T-cell lymphoma can present with a multiple lytic lesion, anaemia, hypercalcaemia. Although B-cell non-Hodgkin's lymphoma can present with the above manifestation, it is extremely rare for T-cell non-Hodgkin's lymphoma.

Effect of iron deficiency anemia on hemoglobin A1c levels.

BACKGROUND: Iron deficiency anemia is the most common form of anemia in India. Hemoglobin A1c (HbA1c) is used in diabetic patients as an index of glycemic control reflecting glucose levels of the previous 3 months. Like blood sugar levels, HbA1c levels are also affected by the presence of variant hemoglobins, hemolytic anemias, nutritional anemias, uremia, pregnancy, and acute blood loss. However, reports on the effects of iron deficiency anemia on HbA1c levels are inconsistent. We conducted a study to analyze the effects of iron deficiency anemia on HbA1c levels and to assess whether treatment of iron deficiency anemia affects HbA1c levels. METHODS: Fifty patients confirmed to have iron deficiency anemia were enrolled in this study. HbA1c and absolute HbA1c levels were measured both at baseline and at 2 months after treatment, and these values were compared with those in the control population. RESULTS: The mean baseline HbA1c level in anemic patients (4.6%) was significantly lower than that in the control group (5.5%, P<0.05). A significant increase was observed in the patients' absolute HbA1c levels at 2 months after treatment (0.29 g/dL vs. 0.73 g/dL, P<0.01). There was a significant difference between the baseline values of patients and controls (0.29 g/dL vs. 0.74 g/dL, P<0.01). CONCLUSIONS: In contrast to the observations of previous studies, ours showed that HbA1c levels and absolute HbA1c levels increased with treatment of iron deficiency anemia. This could be attributable to nutritional deficiency and/or certain unknown variables. Further studies are warranted.

Thrombosed persistent median artery causing carpal tunnel syndrome associated with bifurcated median nerve: A case report.

BACKGROUND: Carpal tunnel syndrome is a sporadically occurring abnormality due to compression of median nerve. It is exceedingly rare for it to be caused by thrombosis of persistent median artery. CASE REPORT: A forty two year old female was referred for ultrasound examination due to ongoing wrist pain, not relived by pain killers and mild paresthesia on the radial side of the hand. High resolution ultrasound and Doppler revealed a thrombosed persistent median artery and associated bifurcated median nerve. The thrombus resolved on treatment with anticoagulants. CONCLUSIONS: Ultrasound examination of the wrist when done for patients with carpal tunnel syndrome should preferably include looking for persistent median artery and its patency.

A rapidly developing lung mass diagnosed as desmoplastic small round cell tumor.

We present a case of a young male who presented with complaints of fever along with cough and sputum. He was diagnosed with having right pleural effusion. He was already taking anti-tubercular therapy for one month before presentation. He was started on intravenous antibiotics and continued on anti-tubercular therapy in our hospital, based on his high leukocyte count, pleural fluid analysis, and ultrasonographic report of multiple hypoechoic areas in the liver. His symptoms continued to worsen and he subsequently developed mediastinal widening and a left lung mass. Commuted tomography (CT)-guided biopsy of the lung mass revealed a desmoplastic small-round-cell tumor. Desmoplastic small-round-cell tumor is a rare and aggressive tumor, which presents rarely as a mediastinal and lung mass. This tumor has very poor prognosis.