Evaluation of the SARC-F Questionnaire as a Diagnostic Tool for Sarcopenia in Geriatric Age-group in India.

INTRODUCTION: With medical science advancing in leaps and bounds, average lifespan is now trending upward, and we are now facing an increasing prevalence of diseases of the elderly, sarcopenia being one of them. Unfortunately, sarcopenia, especially in India, remains to be frequently overlooked, underdiagnosed, and largely understudied. One of the greatest hindrances to the diagnosis of sarcopenia is high costs and limited availability of diagnostic modalities such as magnetic resonance imaging (MRI) and dual energy X-ray absorptiometry (DEXA) scan. Accessible, feasible, and affordable means to diagnose sarcopenia is thus the need of the hour. MATERIALS AND METHODS: We performed a cross-sectional observational study among 300 patients aged 65 years or above (including both outpatient and inpatient departments) at MM Institute of Medical Sciences, Mullana between June 2021 and June 2022. Patients were evaluated as per the European Working Group for Sarcopenia in Older People (EWGSOP) algorithm using bioelectrical impedance analysis (BIA) and the results were compared with results of the SARC-F questionnaire. Statistical analyses were then carried out using IBM Statistical Package for the Social Sciences (SPSS) Statistics version 26. RESULTS: Out of 300 patients, 56 (18.7%) were sarcopenic. Sarcopenia showed no significant association with sex (p = 0.74). SARC-F showed a sensitivity of 73.2% and a specificity of 37.3% with a positive predictive value of 86.51% and a negative predictive value of 32.84% in diagnosing sarcopenia. SARC-F showed good internal reliability with a Cronbach's α > 0.7. CONCLUSION: The SARC-F questionnaire can be used as a bedside screening tool for sarcopenia, especially in a developing country like India where diagnostic resources are frequently scarce.

Enhanced removal of iron (Fe) and manganese (Mn) ions from contaminated water using graphene oxide-decorated polyethersulphone membranes: Synthesis and characterization.

This study addresses the urgent issue of water pollution caused by iron (Fe) and manganese (Mn) ions. It introduces an innovative approach using graphene oxide (GO) and GO-decorated polyethersulphone (PES) membranes to efficiently remove these ions from contaminated water. The process involves integrating GO into PES membranes to enhance their adsorption capacity. Characterization techniques, including scanning electron microscopy, Fourier-transform infrared, and contact angle measurements, were used to assess structural and surface properties. The modified membranes demonstrated significantly improved adsorption compared to pristine PES. Notably, they achieved over 94% removal of Mn2+ and 93.6% of Fe2+ in the first filtration cycle for water with an initial concentration of 100 ppm. Continuous filtration for up to five cycles maintained removal rates above 60%. This research advances water purification materials, offering a promising solution for heavy metal ion removal. GO-decorated PES membranes may find application in large-scale water treatment, addressing environmental and public health concerns.

Anomalous diffusion of E. coli under microfluidic confinement and chemical gradient.

We report a two-layer microfluidic device to study the combined effect of confinement and chemical gradient on the motility of wild-type E. coli. We track individual E. coli in 50 µm and 10 µm wide microchannels, with a channel height of 2 µm, to generate quasi-2D conditions. We find that contrary to expectations, bacterial trajectories are superdiffusive even in the absence of a chemical (glucose) gradient. The superdiffusive behaviour becomes more pronounced upon introducing a chemical gradient or strengthening the lateral confinement. Run length distributions for weak lateral confinement in the absence of chemical gradients follow an exponential distribution. Both confinement and chemoattraction induce deviations from this behaviour, with the run length distributions approaching a power-law form under these conditions. Both confinement and chemoattraction suppress large-angle tumbles as well. Our results suggest that wild-type E. coli modulates both its runs and tumbles in a similar manner under physical confinement and chemical gradient. Our findings have implications for understanding how bacteria modulate their motility behaviour in natural habitats.

Cost of screening, out-of-pocket expenditure & quality of life for diabetes & hypertension in India.

Background & objectives: The Government of India has initiated a population based screening (PBS) for noncommunicable diseases (NCDs). A health technology assessment agency in India commissioned a study to assess the cost-effectiveness of screening diabetes and hypertension. The present study was undertaken to estimate the cost of PBS for Type II diabetes and hypertension. Second, out-of-pocket expenditure (OOPE) for outpatient care and health-related quality of life (HRQoL) among diabetes and hypertension patients were estimated. Methods: Economic cost of PBS of diabetes and hypertension was assessed using micro-costing methodology from a health system perspective in two States. A total of 165 outpatients with diabetes, 300 with hypertension and 497 with both were recruited to collect data on OOPE and HRQoL. Results: On coverage of 50 per cent, the PBS of diabetes and hypertension incurred a cost of ₹ 45.2 per person screened. The mean OOPE on outpatient consultation for a patient with diabetes, hypertension and both diabetes and hypertension was ₹ 4381 (95% confidence interval [CI]: 3786-4976), ₹ 1427 (95% CI: 1278-1576) and ₹ 3932 (95% CI: 3614-4250), respectively. Catastrophic health expenditure was incurred by 20, 1.3 and 14.8 per cent of patients with diabetes, hypertension and both diabetes and hypertension, respectively. The mean HRQoL score of patients with diabetes, hypertension and both was 0.76 (95% CI: 0.72-0.8), 0.89 (95% CI: 0.87-0.91) and 0.68 (95% CI: 0.66-0.7), respectively. Interpretations & conclusions: The findings of our study are useful for assessing cost-effectiveness of screening strategies for diabetes and hypertension.

Objective-structured clinical examination in cardiovascular system for the assessment of internal medicine postgraduates amidst the Covid-19 pandemic.

Background The Covid-19 pandemic has posed a challenge to organizing a safe clinical assessment for postgraduate degree candidates completing the residency programmes in various specialties. Although minimizing the risk of Covid-19 transmission is a priority, fulfilling the objectives of the assessment is equally important. Methods We conducted this study in the Department of Internal Medicine at our institute. Instead of physically examining patients, case scenarios that included history, clinical and investigational data of the cardiovascular system (CVS) were presented to the candidates. Performance was scored by both the conventional and the CVS objective-structured clinical examination (CVS-OSCE) method and compared. Results Clinical assessment examination of 27 candidates for the degree of Doctor of Medicine showed that the median cumulative score gained in narrating and analysing various differential diagnoses was lower compared to the mean cumulative score gained in arriving at a single correct diagnosis (50% [interquartile range-IQR 39%-64%] v. 79% [IQR 64%-100%], p<0.01). Most of the candidates agreed that case scenarios were good alternatives to the conventional physical examination amidst the pandemic. Conclusion CVS-OSCE-based assessment using structured case scenarios is a feasible and effective alternative for clinical skill assessment in high-stake examinations.

A facile and efficient multicomponent ultrasound-assisted "on water" synthesis of benzodiazepine ring.

A facile and efficient multicomponent synthesis of benzodiazepine ring in water under ultrasound irradiation is reported first time. The current procedure escapes traditional chromatography and purification process and provided the product in excellent yields of 95% as compared to conventional methods. The approach was also validated on gram-scale synthesis.

Fever of Unknown Origin in Older Adults: A Prospective Observational Study from North India.

OBJECTIVES: Fever of unknown origin (FUO) has different etiology in different age groups. We aimed to determine the spectrum of FUO in older patients and to establish the underlying etiology. METHODS: This was a hospital-based prospective observational study conducted between January 2018 to June 2019 at Postgraduate Institute of Medical Education and Research, Chandigarh, India. Fifty-one consecutive patients aged 60 years and above met the qualitative criteria of FUO. RESULTS: The etiological distribution was infections in 21 patients (41.2%), malignancies in 16 (31.4%) and noninfectious inflammatory disorders in 8 (15.7%). Six patients (11.8%) remained undiagnosed. Among infections, 15 patients (29.4%) had tuberculosis, and 10 had an extrapulmonary disease. Twelve out of 16 cases with malignancies had a hematological cause, and eight had lymphoma. ;Regarding decisive methods of diagnosis, 18F-fluorodeoxyglucose positron emission tomography was diagnostic in 17 out of 27 patients (63%) and computed tomography in 21 out of 42 cases (50%). Imaging or endoscopy-guided procedures provided a diagnostic clue in 12 out of 14 patients (85.7%), and bone marrow examination results were useful in 9 out of 19 (47.4%). CONCLUSIONS: Infections and malignancies contributed to about three-fourths of cases, with tuberculosis and lymphoma being the commonest etiologies.

Lemon juice catalyzed C-C bond formation via C-H activation of methylarene: a sustainable synthesis of chromenopyrimidines.

An economical and proficient approach has been developed for the synthesis of chromenopyrimidines via three-component reaction of thiobarbituric acid/barbituric acid, methylarenes and dimedone/1,3-cyclohexanedione by using lemon juice as a natural, biodegradable catalyst and TBHP as an oxidant. This transformation involves metal-free C-C bond formation via C-H activation of methylarenes under mild reaction conditions.

Scrub typhus cholecystitis.

Acute acalculous cholecystitis is usually seen in association with systemic medical illness, or after surgery, trauma or burn and is considered as a more severe disease than acute calculous cholecystitis. We recently had the opportunity of observing a patient who was admitted in a surgical emergency with clinical features of acute cholecystitis and was found to have Orientia tsutsugamushi infection after a strong clinical suspicion of acute tropical fever illness.

Assessment of functional status and daily life problems faced by elderly in a North Indian city.

BACKGROUND: The increase in proportion of elderly implies that their problems demand more attention of the administrators. The current study was carried out to assess the functional status of the elderly and to explore the extent and pattern of routine daily life problems faced by them. METHODS: An integrated qualitative and quantitative research design was employed. A stratified multistage random sampling technique was used to select the respondents from various areas of Chandigarh. The houses were selected randomly from where elderly persons (> 60 years) were identified. Katz Index of Independence in activities of daily living (ADL) was used to evaluate functional ability of the respondents. Instrumental ADLs (IADLs) were assessed using Lawton and Brody scale. Focus group discussions and in-depth interviews were conducted among the elderly to explore their problems using an interview guide. RESULTS: One thousand and eighty elderly were enrolled in the study. Their mean age was 67.22 ± 7.54 years. (range 60-102 years). The majority (70%) were independent in carrying out their daily life activities. Financially, around one-third were completely dependent and around half were partially dependent. Major dependence was in food preparation, housekeeping and laundry. From the qualitative data, four main themes were formulated, that is general personal problems of elderly; family problems; problems faced by elderly in hospitals and at public places. A feeling of purposelessness, financial insecurity, physical dependency, problems in hospitals and so on, emerged as the main problems. CONCLUSIONS: Majority of the elderly considered their lives as problematic because they were dependent physically as well as financially. The main domains of dependency were problems related to bowel continence, food preparation, housekeeping and laundry.

Dengue: Uncommon Neurological Presentations of a Common Tropical Illness.

Dengue is a common arthropod-borne flavivirus and commonly manifests as fever, bleeding diathesis, and capillary leak syndrome. Neurological manifestations are uncommon except for encephalopathy. We have recently had the opportunity of observing two patients with rare neurological complications of dengue, transverse myelitis, and Guillain-Barré syndrome. Both the cases had good neurological recovery with steroid and intravenous immunoglobulin, respectively. How to cite this article: Singh H, Pannu AK, Bhalla A, Suri V, Kumari S. Dengue: Uncommon Neurological Presentations of a Common Tropical Illness. Indian J Crit Care Med 2019;23(6):274-275.

Methemoglobinemia in a Case of Paint Thinner Intoxication, Treated Successfully with Vitamin C.

BACKGROUND: Methemoglobin (MetHb) is an oxidized form of hemoglobin. It is a poor transporter of oxygen and is unable to deliver oxygen to the tissue. Globally, drug & toxin induced methemoglobinemia is more common as compared with the congenital form. Methemoglobinemia caused by paint thinner intoxication is rare. Methylene blue is well established as the first-line therapy for severe methemoglobinemia. CASE REPORT: A 25-year old man was brought to the Emergency Department after accidental consumption of paint thinner. On clinical examination, he had cyanosis and there were discrepancies in his pulse oximetry and arterial blood gas (ABG) analysis results. With this clue and supporting laboratory investigations, the diagnosis of toxin-induced methemoglobinemia was made. Due to the unavailability of methylene blue, alternative treatment with high-dose vitamin C was attempted, to which the patient responded. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: The role of vitamin C in the treatment of methemoglobinemia has not been well established, with only a few published case reports. This patient had severe methemoglobinemia, with MetHb of 46.4%, which responded dramatically to vitamin C therapy, with no side effects. This case shows that high-dose vitamin C is safe and has the potential to be an effective alternative for the treatment of severe methemoglobinemia. In the presence of cyanosis, mismatch of pulse-oximetry and ABG-analysis are the key for the physician to suspect methemoglobinemia.

A Curious Case of "Septic Shock".

BACKGROUND: Takayasu arteritis, also known as "pulseless disease," causes proximal occlusion of the lumen of large arteries of the neck and arm, leading to impalpable pulses and "pseudohypotension." This may misdirect the management plan for a patient in the emergency setting if the presence of vascular occlusion is not previously known. CASE REPORT: We describe a young woman who presented to the emergency department (ED) with fever. On evaluation, she had shock, which was not responsive to a fluid bolus. Bedside Rapid Diagnostic Test was positive for Plasmodium vivax, and a diagnosis of severe vivax malaria was made. She was started on intravenous artesunate and vasopressors in view of her persistent hypotension in the face of a normal central venous pressure. A thorough examination at that time revealed palpable lower limb pulses with feeble upper limb pulses. Vasopressors were tapered while monitoring lower limb blood pressure. Computed tomographic angiogram confirmed the diagnosis of Takayasu arteritis. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Hypotension and shock are regularly encountered in the ED. Occlusive arterial disease involving upper limbs can mimic refractory shock, leading to potentially harmful and unnecessary interventions. Emergency physicians should be aware of this possibility. A simple routine of quickly checking all peripheral pulses would help them avoid this pitfall.

Preventive role of carvedilol in adriamycin-induced cardiomyopathy.

BACKGROUND & OBJECTIVES: Adriamycin though considered as an effective anticancer drug, leads to irreversible cardiomyopathy (CMP) and congestive heart failure (CHF). The aim of this study was to determine the protective effect of carvedilol in adriamycin (ADR)-induced cardiomyopathy (CMP) in cancer patients. METHODS: Patients with lymphoreticular malignancy in whom ADR therapy was planned were randomized into two groups: carvedilol and control. Twenty seven patients each were enrolled in carvedilol and control groups. In the carvedilol group, 12.5 mg once daily oral carvedilol was given during six months. The patients were evaluated by echocardiography before and after chemotherapy. Left ventricular ejection fraction (EF) and systolic and diastolic diameters were calculated. RESULTS: At six months of follow up, six patients in the carvedilol group and five in the control group had died. The mean EF (63.19 vs. 63.88%) and fraction shortening (FS) (34 vs. 34.6) of the carvedilol group were similar at follow up, but in the control group, the mean EF (67.27 vs. 60.82%, P =0.003) and FS (38.48 vs. 34.6, P<0.05) at control echocardiography were significantly lower. In carvedilol group, both systolic and diastolic diameters were not changed, but in control group, systolic diameters were significantly increased compared with basal measures (left ventricular end systolic diameter = 28.26±5.50 mm vs. 31.25± 6.50 mm; P< 0.05). INTERPRETATION & CONCLUSIONS: Prophylactic use of carvedilol in patients receiving anthracycline protected systolic functions of the left ventricle. Carvedilol can be a potential drug which can ameliorate ADR-induced CMP.

Assessment and spatial distribution of groundwater quality in industrial areas of Ghaziabad, India.

An attempt has been made in this study to evaluate the groundwater quality in two industrial blocks of Ghaziabad district. Groundwater samples were collected from shallow wells, deep wells and hand pumps of two heavily industrialized blocks, namely Bulandshahar road industrial area and Meerut road industrial area in Ghaziabad district for assessing their suitability for various uses. Samples were collected from 30 sites in each block before and after monsoon. They were analyzed for a total of 23 elements, namely, Ag, Al, As, B, Ba, Be, Ca, Cd, Co, Cr, Cu, Fe, K, Mg, Mn, Na, Ni, P, Pb, Se, U, V, and Zn. In addition to these elements, some other parameters were also studied viz: color, odor, turbidity, biological oxygen demand, chemical oxygen demand (COD), dissolved oxygen, total dissolved solids and total suspended solid. The water quality index was also calculated based on some of the parameters estimated. Out of the 23 elements, the mean values of 12 elements, namely, Al, As, Ca, Cd, Cr, Mg, Mn, Na, Ni, Pb, Se, and U, were higher than the prescribed standard limits. The concentrations (in milligram per liter) of highly toxic metals viz., Al, As, Cd, Cr, Ni, Pb, Se, and U, ranged from 1.33-6.30, 0.04-0.54, 0.005-0.013, 4.51-7.09, 0.14-0.27, 0.13-0.32, 0.16-2.11, and 0.10-1.21, respectively, in all groundwater samples, while the permissible limits of these elements as per WHO/BIS standards for drinking are 0.2, 0.01, 0.003, 0.05, 0.07, 0.01, 0.04, and 0.03 mg L(-1), respectively. The EC, pH, and COD in all samples varied from 0.74-4.21, 6.05-7.72, and 4.5-20.0 while their permissible limits are 0.7 dS m(-1), 6.5-8.5, and 10 mg L(-1), respectively. On the basis of the above-mentioned parameters, the water quality index of all groundwater samples ranged from 101 to 491, and 871 to 2904 with mean value of 265 and 1,174 based on two criteria, i.e., physico-chemical and metal contaminations, respectively while the prescribed safe limit for drinking is below 50. The results revealed that the groundwater in the two blocks is unfit for drinking as per WHO/BIS guidelines. The presence of elements like As, Se, and U in toxic amounts is a matter of serious concern.

Phenylthiourea-mediated experimental depigmentation reduces seizurogenic response of pentylenetetrazol in zebrafish larva.

Zebrafish larvae exposed to chemoconvulsants show behavioral seizures and electrographic abnormalities similar to the other mammalian models, making it a potential tool in epilepsy research. During the embryonic stage, zebrafish remains transparent which enables real-time developmental detection and in-situ gene/protein expression. However, pigmentation during the larval stage restricts transparency. Phenylthiourea (1-phenyl-2-thiourea; PTU) is a commonly used pigmentation blocker that maintains larval transparency. It is widely used along with chemoconvulsants to study in situ expressions in epileptic larvae, however, its effect on seizures largely remains unknown. Therefore, in the present study, the effect of PTU-mediated depigmentation was studied on pentylenetetrazol (PTZ)-induced seizures in zebrafish larvae. After spawning, the fish embryos were subjected to standard depigmentation protocol using 0.13 mM PTU. At 7-days post fertilization seizures were induced using 8 mM PTZ. PTU exposure significantly reduced PTZ-mediated hyperactive responses indicated by decreased distance travelled and swimming velocity of the larvae. Furthermore, PTU-exposed depigmented larvae also showed an increase in the latency to the onset of PTZ-mediated clonic-like seizures. The results concluded that PTU depigmentation protocol reduces the seizurogenic response of PTZ, hence its usage for imaging zebrafish larvae must be carefully monitored to avoid erroneous results.

Biochar aided priming of carbon and nutrient availability in three soil orders of India.

In recent years biochar (BC) has gained importance for its huge carbon (C) sequestration potential and positive effects on various soil functions. However, there is a paucity of information on the long-term impact of BC on the priming effect and nutrient availability in soil with different properties. This study investigates the effects of BC prepared from rice husk (RBC4, RBC6), sugarcane bagasse (SBC4, SBC6) and mustard stalk (MBC4, MBC6) at 400 and 600 °C on soil C priming and nitrogen (N), phosphorus (P), and potassium (K) availability in an Alfisol, Inceptisol, and Mollisol. BC properties were analyzed, and its decomposition in three soil orders was studied for 290 days in an incubation experiment. Post-incubation, available N, P, and K in soil were estimated. CO2 evolution from BC and soil alone was also studied to determine the direction of priming effect on native soil C. Increasing pyrolysis temperature enhanced pH and EC of most of the BC. The pyrolysis temperature did not show clear trend with respect to priming effect and nutrient availability across feedstock and soil type. MBC6 increased C mineralization in all the soil orders while RBC6 in Alfisol and SBC6 in both Inceptisol and Mollisol demonstrated high negative priming, making them potential amendments for preserving native soil C. Most of the BC showed negative priming of native SOC in long run (290 days) but all these BC enhanced the available N, P, and K in soil. SBC4 enhanced N availability in Alfisol and Inceptisol, RBC4 improved N and P availability in Mollisol and P in Alfisol and MBC6 increased K availability in all the soils. Thus, based on management goals, tailored BC or blending different BC can efficiently improve C sequestration and boost soil fertility.