Estimating Time Window to Administer Anti-Cytokine Therapeutic Drugs to COVID-19 Patients.

The severe COVID-19 infection often leads to "Cytokine Release Syndrome (CRS)", which is a serious adverse medical condition causing multiple organ failures. Anti-cytokine therapy has shown promising results for the treatment of the CRS. As part of the anti-cytokine therapy, the immuno-suppressants or anti-inflammatory drugs are infused to block the release of cytokine molecules. However, determining the time window to infuse the required dose of drugs is challenging due to the complex processes involving the release of inflammatory markers, such as IL-6 and C-reactive protein (CRP) molecules. In this work, we develop a molecular communication channel to model the transmission, propagation, and reception of cytokine molecules. The proposed analytical model can be used as a framework to estimate the time window to administer anti-cytokine drugs to get successful outcomes. Simulation results show that at a 50 s-1 release rate of IL-6 molecules, the cytokine storm is triggered at ~ 10 hours, and consequently, the CRP molecules reach the severe level of 97 mg/L at ~ 20 hours. Further, the results reveal that with one-half of the release rate of IL-6 molecules, the time to observe the severe level of 97 mg/L CRP molecules increases by 50%.

Clinico-Pathological Study of Cutaneous Granulomatous Lesions- a 5 yr Experience in a Tertiary Care Hospital in India.

BACKGROUND: Granulomatous dermatoses are common skin pathology, often need histopathological confirmation for diagnosis. Histologically six sub-types of granulomas found in granulomatous skin diseases- tuberculoid, sarcoidal, necrobiotic, suppurative, foreign body & histoid type. The aims of the present study were clinico-pathological evaluation of granulomatous skin lesions and their etiological classification based on histopathological examination. METHODS: It was a five years (Jan 2009- Dec 2013) retrospective study involving all the skin biopsies. Detailed clinical and histopathological features were analyzed and granulomatous skin lesions were categorized according to type of granuloma & etiology. Special stains were used in few cases for diagnostic purpose. RESULTS: Among 1280 skin biopsies, 186 cases (14.53%) were granulomatous skin lesions with a ratio 1:24. In histopathological sub-typing, tuberculoid granuloma was most common type (126 cases, 67.74%). Most common etiology of granuloma in the study was leprosy (107 cases, 57.52%). Other etiologies were cutaneous tuberculosis, foreign body granulomas, fungal lesions, cutaneous leishmaniasis, sarcoidosis and granuloma annulare. CONCLUSION: Histopathology is established as gold standard investigation for diagnosis, categorization and clinico-pathological correlation of granulomatous skin lesions.

Effect of dexmedetomidine as adjuvant in ropivacaine-induced supraclavicular brachial plexus block: A prospective, double-blinded and randomized controlled study.

BACKGROUND AND AIMS: Different additives have been used to prolong brachial plexus block. We evaluated the effect of adding dexmedetomidine to ropivacaine for supraclavicular brachial plexus blockade. The primary endpoints were the onset and duration of sensory and motor block and duration of analgesia. MATERIALS AND METHODS: A total of 84 patients (20-50 years) posted for elective forearm and hand surgery under supraclavicular brachial plexus block were divided into two equal groups (Group R and RD) in a randomized, double-blind fashion. In group RD (n = 42) 30 ml 0.5% ropivacaine +1 ml (100 µg) of dexmedetomidine and group R (n = 42) 30 ml 0.5% ropivacaine +1 ml normal saline were administered in supraclavicular block. Sensory and motor block onset times and block durations, time to first analgesic use, total analgesic need, postoperative visual analog scale (VAS), hemodynamics and side-effects were recorded for each patient. RESULTS: Though with similar demographic profile in both groups, sensory and motor block in group RD (P < 0.05) was earlier than group R. Sensory and motor block duration and time to first analgesic use were significantly longer and the total need for rescue analgesics was lower in group RD (P < 0.05) than group R. Post-operative VAS value at 12 h were significantly lower in group RD (P < 0.05). Intra-operative hemodynamics were significantly lower in group RD (P < 0.05) without any appreciable side-effects. CONCLUSION: It can be concluded that adding dexmedetomidine to supraclavicular brachial plexus block increases the sensory and motor block duration and time to first analgesic use, and decreases total analgesic use with no side-effects.