COVID-19 in Elderly Patients Surgically Treated for Lower Limbs Fracture

Background: The coronavirus disease 2019 (COVID-19) pandemic outbreak has posed new problems in the context of patients suffering from other diseases. In particular, musculoskeletal sequelae related to the state of debilitation associated with COVID-19 are important to consider in elderly patients undergoing surgery after lower limbs fracture, especially in the post-operative period. The objective of this study was to evaluate whether COVID-19 influenced biochemical parameter, recovery and mortality of surgically treated patients suffering from lower extremity fractures. Methods: Laboratory and clinical data of 30 patients were extrapolated and analyzed in the pre-operative and post-operative periods. Among these patients, 13 had COVID-19 infection (COVID-19 +), whereas 17 had no signs of COVID-19 infections (COVID-19 −). Long-term clinical and functional outcomes were also analyzed. Results: Lower calcium, slightly higher values of CRP and much higher values of CPK and AST were observed pre-operatively in COVID-19 + patients, who also showed higher prevalence of long-term sequelae than COVID-19 − patients. Conclusions: COVID-19 affects long-term outcome of elderly patients with lower limb fractures in a multifactorial way. First, the virus directly damages the muscle tissue. Secondly, the lung function impairment worsens the overall performance, making rehabilitation more challenging.

The Research on Perioperative Blood Glucose and Insulin Levels of Patients with Single Insulinoma

Background The blood glucose level is an important biochemical parameter for evaluating the resection effectiveness of insulinomas. However, whether other biochemical parameters have better evaluating ability remains unclear. The current study aims to compare the evaluating capability of blood glucose and insulin levels at several aspects, such as the accuracy and response time. Methods Between September 2017 and July 2018, 21 insulinoma patients with single tumor who underwent surgical resection were enrolled. Peripheral venous blood samples were assayed for blood glucose and insulin levels on the day of surgery and at 30 minutes, 60 minutes, 1 day, and 7 days after surgery. The evaluating abilities of blood glucose and insulin levels for resection effectiveness were recorded and compared. Results The evaluating performance of the insulin level was better than that of the blood glucose level (100% for 21 patients vs 82.4% for 17 patients), as well as the response time ( p<0.0001). Furthermore, the insulin level was not effected by intravenous glucose infusion compared to the blood glucose level. Conclusions Comparing with blood glucose level, insulin level is a better parameter for evaluating resection effectiveness of insulinomas with faster response and regardless of perioperative intravenous glucose infusion.

Administration and Toxicity Profile of the Capizzi Interim Maintenance—Retrospective Study from a Tertiary Care Cancer Centre

Introduction The Capizzi-style methotrexate (MTX) is an integral part of acute lymphoblastic leukemia (ALL) treatment. The escalating dose of MTX originally used in the United Kingdom and Children’s Oncology Group protocols along with L-asparaginase has been modified in the Indian Childhood Collaborative Leukemia (ICiCLe) group protocol where L-asparaginase has been omitted. The data regarding the incidence of toxicities and ease of administration on the Capizzi-style interim maintenance is not robust. Objectives We have compiled our experience with administration and toxicity profile in children with intermediate-risk ALL. Materials and Methods A retrospective data collection of all children diagnosed with intermediate-risk ALL as per the ICiCLe risk stratification in the year 2019 was included in the analysis. Each cycle of MTX was started after ensuring an absolute neutrophil count of >750/mm3 and transaminases <2 upper limit of normal. As a unit protocol, pre- and post-MTX hydration was administered in all our children. No urine pH or midcycle biochemical parameter monitoring was done. Statistical analysis was done using Microsoft Excel and SPSS version 24 IBM Corp. in Armonk, New York, United States. Results Forty-six children were included in the study. The median age of children in our study was 6 years (range: 1 year 2 months–12 years). Undernutrition was associated with a significant increase in toxicity (p = 0.02). Fifty-two percent of children had evidence of toxicity, elevated transaminases being the most common. There were recurring symptoms resulting in 53 episodes of toxicities overall. Incidence of toxicity was more in the early cycles (<3). Conclusion The pre- and post-MTX hydration is an effective way to reduce toxicities with the Capizzi-style MTX and this course can be administered with ease on outpatient basis with minimal need for monitoring or admission.

MANAGEMENT OF CASE OF PRIMARY HYPOTHYROIDISM ON THE PRINCIPLES OF DHATWAGNIMANDYA - A CASE REPORT

Hypothyroidism is a condition caused by thyroid hormone deficiency. It occurs due to hormonal imbalance & decreased metabolism. Clinical manifestations range from no signs or symptoms to life-threatening conditions. In Ayurveda, it corresponds to Dhatvagni Mandya. In this case report the patient presented with puffiness of the face, swelling in both the limbs, muscle (back) pain, loss of appetite, constipation and abnormal weight gain. According to symptomatic presentations, the case was diagnosed as Dhatvagni mandya. Clinical presentation and biochemical parameter i.e., Thyroid Stimulating Hormone (TSH) was 12.07uIU/ml which confirmed the case as Hypothyroidism in modern medicine. The multimodal Ayurvedic management approach incorporating ahara, vihara and aushadha was adopted. The case was treated on the line of principles of Agnimandya. Shaman Chikitsa (pacifying therapy) including internal administration of herbo-mineral formulations such as Arogyavardhini vati, Kanchnaar guggul, Punarnava mandur, Avipattikar churna, Swarna vanga along with a dietary regimen was prescribed to the patient. After 3 months’ treatment, significant symptomatic relief along with reduction of serum TSH level (3.05uIU/ml) without any adverse effects was observed in the patients. It can be inferred from the case that Ayurvedic intervention has enough potential to be employed and utilized in such endocrine disorders. Keywords- Ayurveda, Dhatawagni, Agni, Hypothyroidism, Kanchnar Guggul, Arogyavardhini vati.

Haemato-biochemical Alterations in Obstructive and Non-obstructive Renal Diseases

Background: Diseases involving urinary system are very common in dogs causing significant morbidity and mortality in dogs. Renal failure and urinary obstruction are frequently encountered in clinical cases. Early diagnosis and treatment increase the survival rate and decreases the chances of complications related to renal failure. The present study was conducted to evaluate haemato-biochemical alterations in dogs having urinary system dysfunction. Methods: The study was conducted on 38 dogs to observe the haemato-biochemical parameter changes in dogs suffering from obstructive and non-obstructive renal system affections as compared to healthy dogs. Various haemato-biochemical parameters viz. Hb, PCV, TEC, TLC, DLC, BUN, creatinine, ALT, AST, ALP, TP, albumin and A:G ratio were evaluated. Qualitative analysis of urine was done using Multistix dip stick method. Result: In the present study the values of various haemato-biochemical parameters showed different pattern in both obstructive and non-obstructive renal diseases. Significant haematobiochemical changes reported in renal failure dogs were anemia, azotemia, increased alkaline phosphatase and AST values and decreased A:G ratio and in dogs with urinary obstruction the significant changes were uremia and leukocytosis. The results of the study suggested that the evaluation of various haemato-biochemical parameters help in diagnosis and predicting the prognosis of a renal disease.

Identification and Severity Monitoring of Maize Dwarf Mosaic Virus Infection Based on Hyperspectral Measurements

Prompt monitoring of maize dwarf mosaic virus (MDMV) is critical for the prevention and control of disease and to ensure high crop yield and quality. Here, we first analyzed the spectral differences between MDMV-infected red leaves and healthy leaves and constructed a sensitive index (SI) for measurements. Next, based on the characteristic bands (Rλ) associated with leaf anthocyanins (Anth), we determined vegetation indices (VIs) commonly used in plant physiological and biochemical parameter inversion and established a vegetation index (VIc) by utilizing the combination of two arbitrary bands following the construction principles of NDVI, DVI, RVI, and SAVI. Furthermore, we developed classification models based on linear discriminant analysis (LDA) and support vector machine (SVM) in order to distinguish the red leaves from healthy leaves. Finally, we performed UR, MLR, PLSR, PCR, and SVM simulations on Anth based on Rλ, VIs, VIc, and Rλ + VIs + VIc and indirectly estimated the severity of MDMV infection based on the relationship between the reflection spectra and Anth. Distinct from those of the normal leaves, the spectra of red leaves showed strong reflectance characteristics at 640 nm, and SI increased with increasing Anth. Moreover, the accuracy of the two VIc-based classification models was 100%, which is significantly higher than that of the VIs and Rλ-based models. Among the Anth regression models, the accuracy of the MLR model based on Rλ + VIs + VIc was the highest (R2c = 0.85; R2v = 0.74). The developed models could accurately identify MDMV and estimate the severity of its infection, laying the theoretical foundation for large-scale remote sensing-based monitoring of this virus in the future.

Optic Chiasmatic Hypothalamic Glioma Presented as with Panhypopituitarism with Bilateral Primary Optic Atrophy

Optic chiasmatic hypothalamic gliomas are among common primary neoplasm of the optic nerve. It presents with decreased vision as well as features of hypopituitarism due to infiltration of the hypothalamus. In this case report, a young man presented with loss of libido, increased thirst, gradual loss of vision, bilateral optic atrophy and visual field defect. The MRI of sellar and paraseller region showed optic chiasmaticglioma with hypothalamic extension and biochemical parameter showed panhypopituitarism. We diagnosed this patient as a case of Optic chiasmatic hypothalamic gliomas (OCHGS) with panhypopituitarism with partial cranial diabetes insipidus with bilateral primary optic atrophy.The patient underwent surgery after adequate hormonal treatment but died due to post-operative complications Bangladesh Med J. 2020 Sept; 49(3) : 49-52

Laboratory parameters predicting mortality of adult in-patients with COVID-19 associated cytokine release syndrome treated with high-dose tocilizumab

Large randomized clinical trials in severe Coronavirus Disease 2019 (COVID-19) patients have proven efficacy of intravenous tocilizumab. Our aim was to describe the laboratory parameters predicting in-hospital mortality of patients with tocilizumab administration in COVID-19 associated cytokine release syndrome (CRS).We evaluated high-dose (8 mg/kg) intravenous tocilizumab administration in severe and critically ill COVID-19 adult patients fulfilling predefined strict CRS criteria. A single-centre, prospective, observational cohort study was carried out among consecutive adult (≥18 years of age) in-patients with COVID-19 between April 1 and December 31, 2020. The primary endpoint was 28-day all-cause mortality. The changes in laboratory parameters from baseline on day 7 and 14 after administration of tocilizumab were analysed.In total, 1801 patients were admitted to our centre during the study period. One hundred and six patients received tocilizumab, and among them 62 (58.5%) required intensive care unit admittance while 25 (23.6%) deceased. At day 7 after tocilizumab administration, inflammatory markers (CRP, IL-6, ferritin) and lactate dehydrogenase (LDH) values were significantly lower among survivors. Subsequently, at day 14, differences of IL-6 and LDH levels has become more pronounced between subgroups. Restoration of absolute lymphocyte count (ALC) by day 7 and 14 was insufficient among patients who died.In our cohort, administration of high-dose tocilizumab for COVID-19 patients with CRS demonstrated clinical and sustained biochemical parameter improvement in 76.4%. In this patient population high and increasing LDH, IL-6, and low ALC levels had a predictive role for mortality.