The beneficial role of N-acetylcysteine as an adjunctive drug in treatment of COVID-19 patients in a tertiary care hospital in India: an observational study

Background: N-acetyl cysteine, a mucolytic agent, demonstrates free radical scavenging and anti-inflammatory properties, and prevents endothelial dysfunction by inhibition of NF-KB and formation of no adducts. This has a potential role to tackle cytokine storms, endothelial dysfunction and prothrombotic state observed in COVID-19 manifestations like ARDS and Multi organ dysfunction.Methods: Institution based descriptive cross sectional study, 164 patients from laboratory confirmed RT PCR positive COVID-19 patients, in the study period from 27th May 2020 to 10th August 2020, were assessed, in medical college Kolkata, a dedicated COVID-19 care facility.Results: It was observed that moderate-severe patients who received N-acetyl cysteine along with standard therapy had average hospital stay duration of 12 days, higher rate of discharge, average duration of oxygen therapy of 8 days, less number of deaths and reduced transfer to critical care facilities.Conclusions: N-acetyl cysteine can be considered as an adjunctive therapy with standard protocol driven care, due to its beneficial anti-inflammatory and free radical scavenging properties.

Cell-based Wound Healing: Mechanisms and Treatments.

The ultimate goal of the treatment of wounds is to restore the damaged skin both structurally and functionally to its original state. Conventional treatment of chronic wounds does not seem to work in several cases, so it is necessary to develop different strategies. Recent research advances have shown the great potential of cell-based therapies in improving the pace and quality of wound healing and skin regeneration. Cell-based therapy is thus considered a new alternative to classic methods of wound healing. This review seeks to give an updated overview of the applications of cell-based therapy in wound management. Even though cell therapy is a relatively new tool, several studies prove these types of cells can be used safely, and they have demonstrated their efficacy in healing wounds in several cases.

Liver Function Tests in Type 2 Diabetes Mellitus Patients with and without Oral Hypoglycemic Agents and Statin Intake.

Background: Type 2 diabetes (T2DM) is often associated with liver function abnormalities, covering the entire spectrum from asymptomatic transamnitis to cirrhosis. The oral drugs used in diabetes are also associated with hepatic insult. Aims: Here we have tried to assess the prevalence the liver function test abnormality in type 2 diabetes mellitus patients with special reference to intake of oral hypoglycemic agents (OHA) and statins. Methods: We selected 101 patients of Type 2 Diabetes mellitus (T2DM). Among those diabetic patients 50 were on oral hypoglycemic drugs (OHA) and statins for at least last 6 months. Another 51 age and sex matched patients were diabetic but not on these drugs. The patients were screened for any existing liver disease by biochemical tests. Results and analysis: Our results showed that the prevalence of elevated liver enzymes and bilirubin is more in Diabetic patient than normal values but the oral hypoglycemic drugs and statins had no added effect. Altogether 70 patients (69.3%) had at least one liver function test abnormality. In our study, 4.95% of the patients had elevated bilirubin (>2.5 mg/dL). 24.75% of the study patients had ALT levels above normal (40 U/L) although high values (>100 U/L) were present only in 5 (4.95%). High AST levels (>40) was found in 34.65% cases. Mean alkaline phosphatase levels in 2 groups were similar (213.96 ± 46.2 vs. 222.75 ± 42.52 U/ L). Serum proteins, INR and alkaline phosphatase did not also show any association with drug intake in our study. Conclusion: Thus screening for liver function abnormalities can be a useful test in diabetic population to prevent future complications.

Cryptogenic cirrhosis: Metabolic liver disease due to insulin resistance.

Objective: Etiopathogenesis of cryptogenic cirrhosis (CC) is not yet well established. Up to 20% of non-alcoholic fatty liver disease (NAFLD) may progress to cirrhosis, mostly termed as cryptogenic. Insulin resistance and altered metabolic parameters form a major pathogenic link between NAFLD and CC. CC may thus be actually a metabolic liver disease. Materials and Methods: Thirty-four patients of CC and 32 patients having cirrhosis due to chronic hepatitis B (Hep B) were assessed in a cross-sectional study in a tertiary hospital for insulin resistance, % β-cell activity, obesity indices, plasma glucose, lipid profiles, and many other parameters. Results: CC patients had higher homeostasis model assessment (HOMA)-IR compared to Hep B group (P = 0.000016). A positive correlation between IR values and Child-Pugh score among CC patients was found ("r" = 0.87; P < 0.00001). Out of 34 CC patients, 15 (44.1%) had obesity contrary to 6 (18.8%) in the control group (P = 0.0022). Differences were observed in subcutaneous fat (P = 0.0022), intra-abdominal fat (P = 0.0055), waist circumference (P = 0.014), and percentage body fat (P = 0.047) between the two groups. Significant differences were observed in the levels of triglyceride, total cholesterol, and very low density lipoprotein (VLDL). Conclusion: Most of the CC patients showed significantly higher prevalence of HOMA-IR, obesity indices, and various parameters of "lipotoxicity" and metabolic syndrome, suggesting that CC may be the long-term consequence of a type of "metabolic liver disease." Further studies are required to evaluate the role of therapeutic interventions to enhance insulin sensitivity in such patients.

Case report of two sisters suffering from Weill-Marchesani syndrome with pulmonary stenosis.

We report two sisters having a rare congenital anomaly-Weill-Marchesani syndrome having disproportionate short height, restriction of joint movements, brachydactyly, dislocation of lens, bilateral glaucomatous optic atrophy, and pulmonary stenosis.