Assessment of determining factors for severity of NeoCOVIDiabetes in India: A pan India multicentric retrospective study

BACKGROUND AND AIMS

There is a bidirectional relationship between COVID-19 and diabetes. The primary objective of this study was to estimate the prevalence of patients newly detected to have diabetes (NDD) who recovered from COVID-19 in India whilst comparing NDD with patients without diabetes (ND) and those who have known to have diabetes (KD) in terms of glycemic status pre- and post-COVID with disease severity.

MATERIALS & METHODOLOGY

There were 2212 participants enrolled from 15 sites, with 1630 active participants after the respective execution of selection criteria. Data collection was done using a specialized Case Record Form (CRF). Planned statistical analysis and descriptive statistics were concluded for significance between patient groups on various parameters.

RESULT

The differences in age between the study groups were statistically significant. The average blood glucose at COVID-19 onset was significantly higher in KD than in NDD. Significantly more proportion of NDD (83%) had been hospitalized for COVID management when compared to KD (45%) and ND (55%). The NDD group received higher doses of steroids than the other two groups. On average, patients in the NDD group who received at least one vaccination (one dose or two doses) had a higher High-Resolution Computed Tomography (HRCT) score. Patients who had not been vaccinated in ND and KD groups experienced a higher HRCT score.

CONCLUSION

Prospective metabolism studies in post-acute COVID-19 will be required to understand the etiology, prognosis, and treatment opportunities.

Scientific advisory on nocturnal hypoglycemia in insulin-treated patients with diabetes: Recommendations from Indian experts

INTRODUCTION

Insulin is one of the commonly prescribed glucose lowering agents in diabetes. Hypoglycemia is the most common complication, and severe hypoglycemia is the most serious complication of insulin therapy. Almost half of all severe hypoglycemia episodes (HEs) occur at night. However, patients are often unaware of their nocturnal hypoglycaemia (NH) risk. Additionally, both healthcare professionals and patients find it difficult to manage NH. The purpose of this expert group meeting is to improve NH awareness and provide guidance for the physicians to recognize and manage NH.

METHOD

The panel of experts in an e-board deliberated extensively upon the available literature and guidelines on hypoglycemia and NH discussed the consensus on definition, detection, reporting, monitoring, treatment, and optimization of therapy in NH.

RESULT

& Conclusion: Though there are many guidelines on the management of HEs in patients with diabetes, very few touch the topic of NH. This scientific advisory on management of NH in insulin treated patients with diabetes is formulated to address this gap in understanding regarding management of NH. The experts provide recommendations for the nocturnal window, defining NH based on blood glucose values, recognition, prevention and management of NH.

Medical Professionals Health Conscious Yet the Most Neglected

Medical profession undoubtedly demands high level of devotion, time, and energy. Dealing with situations where human lives are at stake involves persistent work pressure and stress. The long working hours and sedentary job profile affects the overall health of the doctors. The stress, prolonged sitting hours, limited physical activity elevates the possibility of doctors suffering various health problems A 10-year-long study conducted by the Indian Medical Association for Kerala interviewed 10,000 doctors. During the study, 282 doctors died, 87% of them were male physicians and 13% females. When the reason for death was investigated, 27% had died due to heart diseases, 25% due to cancer, 2% by infection, and 1% by committing suicide.

MATERIAL

Doctors attending an educational conclave were requested to undergo certain blood investigations and general examination. Hundred medical professionals agreed to undergo general physical examination and blood investigations. We collected demographic profiles such as age, sex, height, weight and inquired whether he/she is having existing diabetes mellitus or hypertension or not. Five ml of blood sample was drawn and was sent to evaluate haemoglobin, serum creatinine, serum urea, SGOT, SGPT, serum triglyceride, LDL, HDL, TSH & HbA1c levels. Body mass index (BMI) was calculated. For the sake of statistical analysis two age groups were made, doctors less than 50 years age and doctors with more than 50 years of age were compared for various health profiles. Doctors with HbA1c levels less than 6 were compared with levels more than 6. Doctors with haemoglobin level less than 10 were compared with levels of more than 10. Similarly doctors with BMI less than 25 were compared with BMI more than 25.

OBSERVATION

Total 100 doctors participated in the study. The result shows that out of the total sample 78 were male and 22 were females with mean age of 53.41 years. The youngest of the sample was 25 year old and the eldest was 82 years old hence the standard deviation of age is 11.7 years. The height and weight of doctors is significantly different between male (169 cms ± 6.4 cms) and female (155.89 cms ± 7 cms) with p<0.0001. It was also analyzed that BMIs of the doctors are not significantly different. However, weight is significantly different between the doctors having BMI less than 25 and more than 25.

CONCLUSION

In recent decades, affluent populations have become increasingly sedentary, with many adults spending 70% or more of their waking hours sitting and doctors are no different as their work demand lot of sitting hour. Overall, there is a need for continued promotion of doctors' health. We see that the value of the blood sample, height and weight of the doctors show a range of variation. There are many doctors who are overweight and obese. The HbA1C value shows that many of them are DM and some are on the border line. Other values are also alarming and it shows that the doctors need to take proper care of them in term of proper nutrition, physical activity. The study shows that if they continue to be ignorant towards their health, they may develop non- communicable disease.

The transCampus Metabolic Training Programme Explores the Link of SARS-CoV-2 Virus to Metabolic Disease

Currently, we are experiencing a true pandemic of a communicable disease by the virus SARS-CoV-2 holding the whole world firmly in its grasp. Amazingly and unfortunately, this virus uses a metabolic and endocrine pathway via ACE2 to enter our cells causing damage and disease. Our international research training programme funded by the German Research Foundation has a clear mission to train the best students wherever they may come from to learn to tackle the enormous challenges of diabetes and its complications for our society. A modern training programme in diabetes and metabolism does not only involve a thorough understanding of classical physiology, biology and clinical diabetology but has to bring together an interdisciplinary team. With the arrival of the coronavirus pandemic, this prestigious and unique metabolic training programme is facing new challenges but also new opportunities. The consortium of the training programme has recognized early on the need for a guidance and for practical recommendations to cope with the COVID-19 pandemic for the community of patients with metabolic disease, obesity and diabetes. This involves the optimal management from surgical obesity programmes to medications and insulin replacement. We also established a global registry analyzing the dimension and role of metabolic disease including new onset diabetes potentially triggered by the virus. We have involved experts of infectious disease and virology to our faculty with this metabolic training programme to offer the full breadth and scope of expertise needed to meet these scientific challenges. We have all learned that this pandemic does not respect or heed any national borders and that we have to work together as a global community. We believe that this transCampus metabolic training programme provides a prime example how an international team of established experts in the field of metabolism can work together with students from all over the world to address a new pandemic.

Seroprevalence of Trypanosoma cruzi in stray and pet dogs in Grenada, West Indies

American trypanosomiasis (Chagas disease) caused by the protozoan parasite Trypanosoma cruzi is endemic to parts of South America and the Caribbean. Infected dogs are important in the epidemiology of the parasite as they can play a role in the transmission of the parasite to humans. A total of 399 dog sera (242 stray and 157 pet dogs) were examined for T. cruzi infection; using a qualitative immunochromatographic dipstick test, based on recombinant antigens specific for American trypanosomiasis (Trypanosoma detect rapid test; InBios international, Inc., Seattle, Washington). Overall seroprevalence for T. cruzi was estimated at 10.5% (95% confidence interval: 7.5% to 13.5%); with stray dogs being significantly more affected (p<0.05, χ2). Results from this study indicate that dogs in Grenada are moderately exposed to T. cruzi compared to other areas in the region.

Effect of short pulsed nonablative infrared laser irradiation on vascular cells in vitro and neointimal hyperplasia in a rabbit balloon injury model

BACKGROUND

Neointimal hyperplasia after PTCA is an important component of restenosis.

METHODS AND RESULTS

Cultures of rabbit endothelial cells and smooth muscle cells (SMCs) were irradiated with different doses of nonablative infrared (1064-nm) radiation. Normalized viability index detected with nondestructive Alamar Blue assay and direct cell count were studied. Our experiments demonstrated dose-dependent cytostatic or cytotoxic effects of laser irradiation. We also evaluated the long-term effect of endoluminal nonablative infrared laser irradiation on neointimal hyperplasia in a rabbit balloon injury model. PTCA of both iliac arteries of 23 New Zealand White rabbits was performed. One iliac artery was subjected to intra-arterial subablative infrared irradiation via a diffuse tip fiber. The contralateral vessel served as control. The diet was supplemented with 0.25% cholesterol and 2% peanut oil for 10 days before and 60 days after PTCA. Morphometry after 60 days showed that intimal areas were 0.76+/-0.18 and 1.85+/-0.30 mm(2) in the laser and control arteries, respectively (P=2.2x10(-11)).

CONCLUSIONS

We conclude that nonablative infrared laser inhibited neointimal hyperplasia after PTCA in cholesterol-fed rabbits for up to 60 days.

Local delivery of c-myc neutrally charged antisense oligonucleotides with transport catheter inhibits myointimal hyperplasia and positively affects vascular remodeling in the rabbit balloon injury model

Myointimal hyperplasia after percutaneous transluminal coronary angioplasty (PTCA) is a key component of the process of restenosis. The c-myc is a critical cell-cycle division protein involved in the formation of neointima. We evaluated the long-term impact of local delivery of c-myc neutrally charged antisense oligonucleotides (Resten-NG) on myointimal hyperplasia after PTCA in a rabbit model. PTCA was performed in the iliac arteries of 25 New Zealand white rabbits, using a Transport catheter at 8 atm for 30 sec, three times; 500 microg Resten-NG (n = 11) or saline (n = 14) was delivered to the PTCA site at 2 atm with the outer balloon for 2 min. The diet was supplemented with 0.25% cholesterol for 10 days before and 60 days after PTCA. Angiography was performed at harvest, and vessels were fixed in formalin, processed, and stained with hematoxylin and eosin (H&E) and Movat. Quantitative angiography showed that local delivery of antisense c-myc at PTCA reduced late luminal loss from 1.8 +/- 0.30 mm in control animals to 0.90 +/- 0.30 mm in the treatment group (P = 0.001). Histological analysis by planimetry showed that intimal areas were 1.67 +/- 0.44 mm(2) and 0.82 +/- 0.32 mm(2) in the control and antisense delivery groups, respectively (P < 0.05). We conclude that local delivery of Resten-NG inhibited myointimal hyperplasia after PTCA in cholesterol-fed rabbits for up to 60 days.

A Correlative study of sinusitis versus headache

Headache is a very annoying condition for patients and also for those trying to tread it.Head aches can be of sinugenic origin, even if this cause may not be suspected from the case history:Average age of onset for sinugenic headache is 25 to 30 years. Sinugenic headache occurs equaliy in both saxes. Diagnosis of sinugenic headache is done by the clinical history,examition of nuse and paranasal sinuses and relevant investigatins besides excluding the headaches of nonsinugenic and pyschogenic cause. Surgical treatment is helpful in curing the patients of sinugenic headaches in most of the cases. Only two patients could benefit with medical treatment. Recurrences are common in patients of headaches of multiple etiology and more if not treated specfically.

Implications of a health lifestyle and medication analysis for improving hypertension control

BACKGROUND

National Health and Nutritional Examination surveys have documented poor rates of hypertension treatment and control, leading to preventable morbidity and mortality.

OBJECTIVES

To examine covariation in the medication and health lifestyle beliefs and behaviors of persons with hypertension to identify and profile distinct subgroups of patients.

METHODS

A sample of 727 patients with hypertension, weighted to match the 1992 National Health Interview Survey age and sex distribution of patients with hypertension, was interviewed by telephone about their beliefs and behaviors regarding hypertension and its management. Cluster analysis of key variables was used to identify 4 patient types.

RESULTS

Subgroups differed significantly. Group A members use an effective mix of medication and health lifestyle regimens to control blood pressure. Group B members are most likely to depend on medication and have high adherence rates. Yet they also have high rates of smoking (29%) and alcohol use (average, 104 times per year) and are less likely to exercise regularly. Group C members are most likely to forget to take medication, are likely to be obese, and find it most difficult to comply with lifestyle changes (except for very low rates of smoking and alcohol use). Group D members are least likely to take medication, most likely to change or stop medication without consulting their physician (20%), most likely to smoke (40%), and least likely to control diet (29%). Group A and B members have better health outcomes than group C and D members.

CONCLUSIONS

Optimal management strategies are likely to differ for the 4 patient types. Further research should be conducted to validate these findings on a separate sample and to devise and test tailored management algorithms for hypertension compliance and control.

Angiogenesis in a patient with ischemic limb induced by intramuscular injection of vascular endothelial growth factor and fibrin platform

Direct revascularization of critical ischemia of the limb is often unsuccessful due to the anatomic extent and distribution of arterial occlusive disease, and no pharmacologic treatment has proved effective in treating this condition. Patients with ischemic limb may eventually require amputation and may develop serious morbidity and mortality. The goal of limb salvage in these patients has stimulated research into alternative treatment methods, including angiogenesis. Attempts have been made to apply growth factors directly or to encode DNA for such factors, but it is unknown whether these factors remain at the target site long enough to be effective. We report our strategy of using vascular endothelial growth factor in a fibrin network, which enables the sustained release of biologic material at the target site.

Prognostic significance of Bcl-2 expression in localized squamous cell carcinoma of the head and neck

This study was conducted to determine whether Bcl-2 overexpression in localized squamous cell carcinoma of the head and neck (SCCHN) might serve as a marker for tumors unlikely to respond to standard treatment. Tissue samples from 33 patients undergoing surgery or irradiation for early-stage SCCHN during the year 1977 to 1992 were stained for Bcl-2. All patients had either T1N0 lesions of the oral cavity, pharynx, or larynx or T1N0 or T2N0 lesions of the true vocal cords. Of the 33 patients, 26 remained disease-free after at least 3 years of follow-up; the remaining 7 patients developed either tumor recurrence or a second primary tumor, 4 of which were fatal. Twelve patients had tissue specimens staining positive for Bcl-2; 6 of these patients had a poor outcome, and 6 had a good outcome. The relationship between poor outcome and overexpression of Bcl-2 in tumor cells was statistically significant (p = .0047 by Fisher's exact test). For tumors overexpressing Bcl-2, there was no significant difference in recurrence rate between those undergoing surgery and those undergoing radiotherapy as the primary mode of treatment. The overexpression of Bcl-2 in early lesions in this study predicted a cure rate of 50%, as opposed to the generally expected 90%, suggesting that Bcl-2 is a significant prognostic indicator in early SCCHN. Future studies will determine if altering the treatment will improve outcome in these patients.

Evaluation of microsomes isolated from fresh and frozen myotomal tissue of Atlantic cod (Gadus morhua)

Microsomes were isolated from fresh and frozen myotomal tissue of Atlantic cod by two procedures. Electron microscopy revealed one method to yield microsomes containing greater quantities of myofibrillar debris than the other and this was reflected as reduced 5'-nucleotidase, acid phosphatase and succinate dehydrogenase marker enzyme activity. Overnight freezing of myotomal tissue did not affect the marker enzyme activity of microsomes isolated by either procedure. Morphological changes were observed among microsomes prepared from myotomal tissue retained for 8 weeks at -30 degrees C. Accordingly, 5'-nucleotidase was marginally elevated and acid phosphatase and succinate dehydrogenase activity reduced in comparison to fresh microsome preparations.