A Systematic Review and Meta-analysis of Diabetes Associated Mortality in Patients with COVID-19.

CONTEXT: Coronavirus disease 2019 (COVID-19) has been one of the deadliest pandemics in recent decade. The virus has specifically targeted the comorbid population in terms of mortality. The present systematic review and meta-analysis aimed to determine the overall mortality and diabetes-associated mortality in COVID-19 patients. METHODS: To obtain the related data, six databases, including Pubmed, Embase, MEDLINE, Web of Science, Google Scholar, and DOAJ, were searched. The full-texts of articles presenting the data of COVID-19 mortality and diabetes-associated mortality were screened and retrieved. Statistical analysis was performed using the Stata (version 13). The odds ratio (OR) of mortality in diabetic patients was calculated with 95% confidence interval (CI). Random-effects model was used to synthesize data for the relevant outcomes. Heterogeneity was evaluated using I2 statistic. Forest plots visually showed the effect estimates of the included studies. We used funnel plots to evaluate potential publication bias. A two tailed P < 0.05 was considered as statistically significant. RESULTS: A total of 35 studies with 25,934 patients were finally included for meta-analysis. The pooled prevalence of diabetes mellitus in patients with COVID-19 was 16.8% (n = 4381). The overall mortality seen in all the studies was 12.81% (n = 3159), and diabetes-associated mortality was 22.14% (n = 970). The pooled analysis of included studies showed that diabetes mellitus had a significantly higher mortality rate (22.14% vs. 12.81%, P < 0.05) with higher odds of death (pooled OR 1.83, 95% CI: 1.61 - 2.05). The funnel plot was symmetric, thereby indicating a low risk of publication bias. CONCLUSIONS: In conclusion, the presence of diabetes was associated with a significantly increased risk of mortality in patients admitted to the hospital with COVID-19. Thus, this subpopulation must be continuously monitored for glycemic levels, coagulation abnormalities, and inflammatory surge.

Mini-Punch Skin Excision: A Newer Novel Approach for Tattoo Removal.

Q-switched Nd:YAG laser remains the gold standard for tattoo removal, but still some tattoos are not completely removed in a specified period as desired by the patient. Herein, we present a case report of 23-year-old patient who came to the outpatient department for tattoo removal. The tattoo measured around 20cm × 18cm and was located on the back. Nine to 12 sessions of 1064-nm Q-switched Nd:YAG laser were planned at 4- to 6-week interval. After the completion of nine sessions, all the shades of the tattoo disappeared, but the lines persisted. A trial of increased laser energy and multiple-pass R20 treatment was performed, which rather increased the scarring and no improvement in tattoo clearance was noticed. We tried mini-punch skin excision for clearing the remnant tattoo lines. The tattoo was cleared successfully without significant scarring. Mini-punch skin excision is a very promising technique, similar to the follicular unit extraction technique of hair transplant, for tattoo removal of the patients who want immediate results as compared to lasers that take almost a year, provided the patient accepts the risk of scarring.

Choroid plexus papilloma.

Choroid plexus tumors are rare intracranial tumors which account for only 0.4-0.6% of all brain tumors. These are intraventricular papillary neoplasms derived from choroid plexus epithelium and range from choroid plexus papillomas (World Health Organisation (WHO) grade I) to choroid plexus carcinomas (WHO grade III). It is an important albeit rare cause of hydrocephalous. We present to you the case of a 1-year-old child who presented with the signs and symptoms of hydrocephalous and was diagnosed as choroid plexus papilloma on histopathology.

A Retrospective Analysis of Apheresis Donor Deferral and Adverse Reactions at a Tertiary Care Centre in India.

INTRODUCTION: With increasing demand of platelet component each day, blood bank plays a pivotal role in ensuring supply of safe blood as and when required. Plateletpheresis procedure is a relatively simple, safe and important adjunct to blood bank inventory. However, recruitment of healthy blood donors is a challenge that the health industry is facing today. AIM: To determine the reasons and rates of apheresis donor deferral along with investigation of adverse reactions encountered during the procedure. MATERIALS AND METHODS: Records of single donor apheresis were retrospectively analysed from 1st January 2010 to 31st December 2014. The study was carried out at Blood Bank, Safdarjung Hospital, New Delhi, India. The donor details that were studied included - age, sex, type of donation (voluntary/replacement/ repeat), reason for donor deferral and type of adverse reaction, if encountered during the procedure. RESULTS: Among the 478 donors screened for plateletpheresis procedure during a study period of 5 years, 134 (28.03%) were deferred. Temporary deferrals accounted for majority (93.28%) of the deferrals. Low platelet count (50.75%) was the main reason of donor deferral followed by low haemoglobin (20.89%). Amongst the 344 selected donors, 15 (4.36%) had some type of adverse reaction associated with the procedure. CONCLUSION: We suggest that the selection criteria for plateletpheresis donors should be revised to deal with shortage of apheresis donors. The criteria regarding minimum pre-procedure platelet count (above1.5 lac/µl) and haemoglobin (above 12.5 g/dl) need to be lowered so as to suit the Indian scenario. The lower adverse reaction rates, 14/344 (4.06%) associated with this procedure encourages safety of donors and is important in recruitment of new donors.

Single organ variant of polyarteritis nodosa in epididymis.

Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that typically affects medium-sized muscular arteries, with occasional involvement of small muscular arteries. Unlike some other vasculitides (e.g. microscopic polyarteritis, Wegener's granulomatosis) PAN is not associated with antineutrophil cytoplasmic antibodies. Patients typically present with systemic symptoms such as fever, weight loss, and malaise. The kidneys, skin, joints, muscles, nerves, and gastrointestinal tract are commonly involved, usually in some combination. PAN can affect any organ, but usually spare the lungs. Clinical variants or subsets of PAN include single-organ disease and cutaneous-only PAN. Scrotal involvement is rarely the first presenting sign. We herein report a case of 36-year-old man who presented with a swelling in the left epididymis, which was surgically removed. The swelling histopathologically showed necrotizing inflammation, fibrinoid necrosis of the medium-sized arteries of the epididymis and was diagnosed to be single organ variant of PAN.

Malignant fibrous histiocytoma of the spleen: an extremely rare entity.

Primary malignant fibrous histiocytoma (MFH) of the spleen is extremely rare. Since the first description of primary splenic MFH reported by Govoni et al in 1982, to the best of our knowledge, only twelve cases of MFH of the spleen have been reported in the literature. We herein report a rare case of primary splenic MFH in a 30-year-old Indian male who presented with abdominal pain with a history of recurrent hydatid cyst of liver and spleen. A computed tomography (CT) scan was performed and a diagnosis of splenic hydatid cyst was made. Splenectomy was done. On histopathological examination, a diagnosis of malignant mesenchymal tumor, possibly storiform variant of malignant fibrous histiocytoma, was made. On immunohistochemistry, the tumor was positive for vimentin and CD68. The post operative period was uneventful. Compared with the twelve previously cases of MFH of the spleen, our patient is the youngest case reported so far.