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Introduction: Gastrointestinal neuropathies are frequently found in diabetic patients. The pathogenesis of diabetic gastroparesis (DG) is multifactorial. The usual treatment for DG includes dietary modifications, prokinetic and antiemetic agents. There is increasing demand for more effective medicines to treat DG. The current study was conducted on the Pistacia lentiscus stem extract to add to the armamentarium of DG treatment and to find the efficacy of P. lentiscus plant extract (mastic gum) in comparison to levosulpiride in DG for improvement in gastroparesis symptoms and gastric emptying scintigraphy (GES) in a single centric double-blind non-inferiority randomised control trial. Methods: Thirty-eight individuals were recruited and equally randomised into two study groups based on Gastroparesis Cardinal Symptom Index (GCSI) score and TC99 Radionuclide GES, mastic gum group and levosulpiride group. Both pre and post-intervention (8 weeks) GCSI scores were calculated, GES was performed to quantify the improvement in gastric emptying. Power analysis was performed using G*POWER software version 3.1.9.7 and data analysis using SPSS 23.0, variables measured in mean ± standard deviation (SD). Various statistical tests were used such as independent t-test, Chi-square test or Fisher's exact test, Wilcox Mann–Whitney test, analysis of variance (ANOVA) test, and posthoc pairwise tests. Results: The mastic gum is found effective in the improvement of 4 h gastric emptying percentage from the mean (SD) 76.60 (± 9.96) to mean (SD) 97.20 (2.17)% (P < 0.001). Mastic gum has the property of HbA1c reduction, which is more significant than that of levosulpiride (P = 0.044). Mastic gum also had significant Low density lipoprotein (LDL) (mg/dL) levels reduction, (P < 0.001), compared to levosupiride. An absolute increase was observed in haemoglobin (HB) level in mastic gum at a 2-month mean (SD) of 1.03 (0.77) (g/dL) (P-value

Kimura disease is an uncommon disease entity that typically involves the lymph nodes predominantly in the head and neck region together with frequent involvement of salivary glands. Very few cases of it have been reported in literature globally, and in the context of India, it is even rare. Early suspicion of Kimura disease may prevent the patient from unnecessary invasive diagnostic tests. We present a case scenario of a 35 years old female, from a hilly area who presented with painless neck swelling for 3 months that was followed by fever, new onset pain at the site of neck swelling, and skin rashes. Diagnosis of Kimura disease was made based on histopathological findings aided by peripheral eosinophilia and elevated serum Immunoglobulin E (IgE) levels. Following the diagnosis, the patient was treated with a short course of oral steroids which produced an excellent response with a consequent decrease in the size of lymph nodes and resolution of the skin rashes.

Background: Limb loss to amputation is a major problem, especially in developing countries where the majority of the cases are preventable. It is a burden, not just for the patient but also for their caregivers. Today, when amputation is necessary, surgery is undertaken with consideration for the functional aspects of the residual limb. The purpose of this study was to describe the etiology and characteristics of major limb amputees at a tertiary care center in North India. Methods: This prospective observational study was conducted by the Government Medical College Jammu, for 2 years. Eighty-one patients underwent major limb amputations in our hospital during the study. In this study, we studied several variables including age, sex, side of the limb, level of the amputation, and etiology. Results: In this study, dysvascular disease was the major reason of amputation, diabetes mellitus being the most common cause (39.5%), followed by trauma, with a male preponderance, with peaking at the age of 51–70 years. Lower limb is the most common with the predominance of transtibial amputation. Younger individuals who underwent amputation were mostly due to the trauma. The most common postoperative complication was surgical site infection (21%) and the most common organism cultured from the wound was Pseudomonas (50%). The most common additional procedure done was wound debridement. The mortality rate was 10% and the mean duration of hospital stay was 23 days. Conclusion: In contrast to declining rates of trauma-related and cancer-related amputations, we found evidence of a significant increase in the incidence of amputations due to diabetic foot syndrome. Overall, the risk of amputations increased with age. This was true for all etiologies and for both sexes. Males with an average age of 50 years are generally at higher risk for limb loss than women.

Diabetes mellitus (DM) is a clinical syndrome that is manifested by hyperglycemia. Out of the numerous causes of diabetes, an uncommon cause is chronic pancreatic disease due to destruction of islet cells. Diabetic ketoacidosis is a rare entity in such cases as alpha cells are destroyed along with beta cells, which causes lack of glucagon that is responsible for ketogenesis. We hereby report a case of a 55-year-old woman with history of gall stone disease and who presented to the emergency department with multiple episodes of non-bilious, non-blood mixed vomiting along with increased frequency of micturition on background of malaise and anorexia along with significant weight loss. Her capillary blood glucose was 501 mg/dl, arterial blood gas showed high anion gap metabolic acidosis, and urine ketone were largely positive. Thus, she was diagnosed with diabetic ketoacidosis. She was admitted to the high dependency unit and her condition was treated along the lines of diabetic ketoacidosis. Further evaluation showed high HbA1c values without previous history of diabetes and computed tomography of the abdomen revealed presence of chronic pancreatitis. Though being a rare entity, this case outlines that DM3c can present with diabetic ketoacidosis (DKA); thus, early diagnosis and management are crucial to prevent mortality.

Objective: The objective of this study is to assess baseline plasma C-reactive protein (CRP) levels in patients with acute coronary syndromes and their significance in prognosis. Materials and Methods: The study was carried out at the department of internal medicine in a tertiary health care center. Fifty patients diagnosed with acute coronary syndromes (ACSs) (ST-elevation acute myocardial infarction (STEMI) or unstable angina (UA)/non-STEMI) were admitted and detailed history, clinical examination, and laboratory tests were done on each patient. All routine blood investigations were carried out along with electrocardiography and echocardiography in all patients. Plasma concentrations of CRP were measured with an ultra-sensitive latex immunoassay before reperfusion, 24 h after admission, and at discharge. Results: A total of 50 patients were taken. Thirty-eight cases were found to be male and the remaining 12 were female, of which 35 were STEMI and 15 were UA/NSTEMI. The maximum prevalence of ACS was observed in the age group of 41–50 years. Among all five presenting symptoms, chest pain was the most prevalent, followed by sweating, breathlessness, vomiting, and giddiness. The major risk factors in ACS include smoking being the most common followed by diabetes and dyslipidemia. In 16 patients, left ventricular failure was recorded, which was the most common complication followed by cardiogenic shock and atrioventricular block. ventricular tachycardia/ventricular fibrillation is recorded in five patients who died, 36 patients with complications, and three patients among 40 patients without complications where CRP levels are ≥0.6 mg/dl. Four patients out of 10 patients who showed CRP levels

Introduction: An ectopic pregnancy occurs when a fertilized egg attaches somewhere outside the uterus.There are many risk factors for ectopic pregnancy. This study will help us to prepare a list of risk factors associated with ectopic pregnancy in our state. In addition, it will help implement a risk-reduction counseling program before conception, which will help us screen high-risk patients and reduce and manage ectopic pregnancy. Materials and methods: The present study was conducted in our department for two years, from August 2018 to July 2019. Cases included all patients with ectopic pregnancy admitted in labor. A total of 192 cases were taken, out of which 8 cases refused to participate in the study, so 184 patients were included in the study. Results: Patients with previous ectopic pregnancy have 6.34 times increased risk of a repeat ectopic pregnancy (odds ratio 6.34, confidence interval 1.40-28.77), and this association was highly significant (p = 0.006). The risk of ectopic pregnancy is 3.02 times increased (odds ratio 3.10; 95% confidence interval, 1.16-7.84) if the patient once had the pelvic inflammatory disease and is statistically significant (p = 0.01). The study also revealed that 17 (10.3%) patients with ectopic pregnancy had a history of tubal ligation or some other tubal surgery done in the past compared to 3 (2.2%) patients among controls, and this finding is statistically highly significant (p = 0.001). Conclusions: In the present study, we found that the main risk factors for incidence of ectopic pregnancy are prior ectopic pregnancy, prior tubal ligation, and prior pelvic/abdominal surgery. In addition, ectopic pregnancy was positively related to the previous history of ectopic pregnancy, abortion, cesarean section, and infertility. These findings can be helpful for early diagnosis of ectopic pregnancy to pursue proper medical therapy instead of unnecessarily surgical treatment.

Introduction: Obesity is strongly associated with other metabolic disorders including Hypertension (HTN), diabetes and Cardiovascular Diseases (CVD). High Blood Pressure (BP) is ranked as the third most important risk factor for attributable burden of disease in South Asia. Aim: The aim of present was to study the association between BP and obesity indices in medical student’s population. Materials and Methods: A cross sectional study was conducted on a group of 100 healthy young medical students. BP, pulse and Hb O2 % was measured by using sphygmomanometer, pulse oximeter. Obesity indices were measured by using weighing machine, stadiometer, measuring tape and impedance based Body Composition Analyser (BCA). Results: There was poor correlation of Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) with Total Body Fat (TF) and the association was not significant. SBP and DBP were mildly correlated with BMI. Whole body Visceral Fat (VF) correlation of SBP was moderate and significant. DBP was correlated with whole body VF and correlation was significant. But the whole body, trunk, leg Skin Fat (SF) and Muscle Fat (MF) were not having significant correlation with SBP and DBP. Finger to heart distance was positively correlated with SBP (p

There is a new public health crises threatening globally with the emergence and spread of 2019 novel coronavirus or the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It is the seventh member of the coronavirus (CoV) family, which infects humans and to which the Middle East Respiratory Syndrome CoV (MERS)-and SARS-CoV also belong. SARS-CoV-2 is a newly emerging human infectious CoV that causes COVID-19, which has been recognized as a pandemic by the World Health Organization on March 11. The most recent outbreak initially presented as pneumonia of unknown etiology as COVID-19 is a pneumonia-like disease with a group of symptoms including fever, dry cough and shortness of breath in a cluster of patients in December 2019 Wuhan, China. The body's immune system tries to protect the body from this pathogen. And as due to its surge in the body, various respiratory and other system-related complications increased. Therefore, in this article, COVID-19 immunopathogenesis is briefly reviewed. Through this review, we try to explain the molecular immune pathogenesis and diagnosis of COVID-19 (SARS-CoV-2) infection, based on the recent research progress of SARS-CoV-2 and the knowledge from researches on SARS-CoV and MERS-CoV.

Introduction: The risk stratification is very important for the management of patients with Acute Coronary Syndrome (ACS). Extraskeletal calcium plays a critical role in a range of biological processes. There is an urgent need to accurately identify, the additional factors which are important in the clinical course and outcome of patients of ACS. Aim: To evaluate impact of baseline serum calcium levels in patients with ACS and to determine prognostic significance of baseline serum calcium levels in patients with ACS. Materials and Methods: The present observational study was conducted in 100 patients of ACS, over a period of one year from December 2018 to December 2019 at Acharya Shri Chander College of Medical Sciences, Sidhra, Jammu and Kashmir, India. They were divided into three tertile ranges as: hypocalcaemic (10.4). The clinical outcome was measured in terms of Left Ventricular Ejection Fraction (LVEF) development of acute pulmonary oedema, rates of emergency revascularisation, development of arrhythmias, recurrence of chest pain, mortality within 7 days of admission, readmission rates with reinfarction or any other cardiovascular complication and finally, mortality within 90 days of follow-up. Quantitative variables were compared using ANOVA/Kruskal Wallis Test between the three groups. Results: The mean age of the study population was 73.29±8.11 years. Baseline calcium on admission was found to be

COVID-19 has caused devastating effects worldwide ever since its origin in December 2019. IL-6 is one of the chief markers used in the management of COVID-19. We conducted a longitudinal study to investigate the role of IL-6 in diagnosis, treatment, and prognosis of COVID-19-related cytokine storm. Patients with COVID-19 who were admitted at AIIMS Rishikesh from March to December 2020 were included in the study. Patients with no baseline IL-6 value at admission and for whom clinical data were not available were excluded. Clinical and laboratory data of these patients were collected from the e-hospital portal and entered in an excel sheet. Correlation was seen with other inflammatory markers and outcomes were assessed using MS Excel 2010 and SPSS software. A total of 131 patients were included in the study. Of these, 74.8% were males, with mean age 55.03 ± 13.57 years, and mean duration from symptom onset being 6.69 ± 6.3 days. A total of 82.4% had WHO severe category COVID-19, with 46.56% having severe hypoxia at presentation and 61.8% of them having some comorbidity. Spearman rank correlation coefficient of IL-6 with D-dimer was 0.203, with LDH was −0.005, with ferritin was 0.3, and with uric acid was 0.123. A total of 11 patients received Tocilizumab at a mean duration from symptom onset of 18.09 days, and 100% mortality was observed. Deaths were reported more in the group with IL-6 ≥ 40 pg/mL (57.1% vs. 40.2%, p = 0.06). ICU admissions and ventilator requirement were higher in the IL-6 ≥ 40 pg/mL group (95.9% vs. 91.4%, p = 0.32 and 55.1% vs. 37.8%, p = 0.05). The study showed that IL-6 can be used as a possible “thrombotic cytokine marker”. Higher values of IL-6 (≥40 pg/mL) are associated with more deaths, ICU admissions, and ventilator requirement.

Key Clinical Message: With the eruption of COVID pandemic, many cases of thromboembolic events in association with the COVID infection were reported suggesting the prothrombotic state associated with the infection. After a few years, eventually some of the COVID vaccines came into implementation. With the discovery and implementation of COVID vaccinations, a very few cases have been reported to have developed thromboembolic events, including pulmonary thromboembolism. Different types of vaccines have been associated with different rates of thromboembolic events. Covishield vaccine is rarely associated with thrombotic complications. In the case report below, we present a case summary of a young married female, who presented with shortness of breath a week after the Covishield vaccination and presented to our tertiary care center with further worsening of symptoms during a course of 6 months. On detailed workup, she was diagnosed to have a large pulmonary thrombus affecting the left main pulmonary artery. Other possible etiologies of the hypercoagulable states were ruled out. Though COVID vaccines are known to induce prothrombotic state in the body, we could not be sure if it was the actual cause for the pulmonary thromboembolism or just a coincidence. [ABSTRACT FROM AUTHOR]