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Background: The fuel used for cooking is a major source of indoor air pollution because of inefficient combustion and inadequate ventilation. This study was conducted to see if there is any association between the type of cooking fuel and common health problems in light of inadequate ventilation. Methods: This was a cross-sectional study; 688 subjects were selected randomly from various sectors and the outlying areas of Surajkund. The impact of indoor air pollution on health was assessed by questionnaires, general physical examination, and pulmonary function testing. Results: One of the key findings of the study has been the implication of LPG, touted as a safe, non-polluting fuel with a definite negative impact on health. There was significantly more breathlessness experienced by LPG users as opposed to the users of wood and cow dung. Though the prevalence of fever in both groups was similar, chest pain, burning of eyes, and fatigue were reported by wood and cow dung users much more frequently. The pulmonary function test showed restrictive pathology in cow dung and wood users, whereas obstructive pathology in LPG users. Conclusions: LPG is considered “clean” fuel because it does not produce visible emissions. However, improper burner design, blocking and clogging of the flue vent, and insufficient combustion air result in improper combustion and the emission of aldehydes, CO, hydrocarbons, and other organics. It would be folly to believe that LPG is harmless. Even a harmless material may become harmful if used inappropriately.

Fireworks are any composition or device designed to produce a visible or audible effect made outof hazardous chemicals. The key hazards involved in firework industries are toxic fumes, fire andexplosion. The objective of this review is to differentiate between old firecrackers and ecofriendly/green firecrackers and their health hazards. Published articles were searched from Med Line, PubMed, Google Scholar and Cochrane library. It is observed that the air concentration of heavy metalsfound in old firecrackers was high during and after firecrackers bursting activities which lead tohealth effects like skin, respiratory, neurological, multiple degrees of burn etc. In ecofriendly firecrackers, the reduction in the chemicals like barium nitrate, potassium nitrate and sulphur leadsto reduction in PM2.5. Enough information is not available related to the ecofriendly firecrackers;hence, drawing a conclusion related to their health at present is difficult. The review identifiedmany health effects as well as accidents (or incidents) related to firecrackers bursting,manufacturing and transportation. Ecofriendly/ Green firecrackers area better substitute of oldfirecrackers as their composition has less harmful contents. Further studies are required toconclude the effects of ecofriendly/green fire crackers as the complete list of their formulations arestill not available.

COVID-19, caused by severe acute respiratory syndrome coronavirus 2 (SARS CoV 2), has put the global health system into crisis. The complications of the disease include respiratory failure, proinflammatory, and thromboembolic presentations. It is being increasingly recognised that host response with the inflammatory and thrombotic state is responsible for the severity of the disease. Numerous studies are now showing that increased inflammatory markers like interleukin (IL) 6 portray a poor prognosis. Thrombo-embolic complications like pulmonary embolism also produce clinical deterioration in COVID 19. The management of the disease presently includes antiviral, anti-inflammatory, and anticoagulant therapy along with supportive care for respiratory complications. The therapeutic challenge is augmented due to the varied clinical presentations, rapid worsening, and lack of a clear understanding of the pathophysiology. The initial data regarding the treatment options are of low quality and are mostly from cohort analysis. Many randomised controlled trials (RCT) are ongoing, and the results from the RCTs will help in developing better treatment options. We discuss in this review the pathophysiology and mechanism behind the increased inflammation and thrombosis. We will also discuss the available therapeutics options and the recommendations of various guidelines regarding the management of the proinflammatory and thrombotic state.

COVID-19 and its sequelae are primarily known to affect the respiratory system. However, it can have varied manifestations affecting other systems as well. COVID-19 can lead to reactivation of tuberculosis whichcan have unusual extrapulmonary presentations as well. Coinfection of COVID-19 and tuberculosis is a risk factor for poor outcome. Here, we describe a series of two cases of COVID-19 with tuberculosis. In the first case, a patient who had apparently recovered from COVID-19 presented only a week later with polyserositis, and ultimately was diagnosed to be a case of disseminated tuberculosis. In the second case, the patient presented with COVID-19 and TB together. Clinicians must be aware and vigilant for this coinfection and complication in COVID-19 recovered patients even if they were of mild/ asymptomatic category. How to cite this article:Daga MK, Kumar N, Mawari G, Chand S, Aarthi J, Raghu RV, Sachdeva K. COVID-19 and TuberculosisCoinfection: A Report of Two Cases. Int J Preven Curat Comm Med. 2021;7(1):20-24. DOI: https://doi.org/10.24321/2454.325X.202103

The global burden of sepsis is overwhelming and novel therapeutic agents is the need of the hour. The present study was designed to understand the role of Malondialdehyde as a marker of the oxidative stress in sepsis, as well as the effect of supplementation of Vitamin C and Thiamine in patients of sepsis.80 patients of sepsis were randomly divided into 4 groups of 20 each. Twenty age-sex matched healthy volunteers were chosen as controls. The first group received Vitamin C, the second group received Thiamine, the third group received both and the fourth group received neither. Vitamin C (2g 8 hourly) and Thiamine (200 mg 12 hourly) were given intravenously for five days. The outcome was recorded in terms of mortality in the various groups as well as by the improvement in SOFA scores (ΔSOFA). The serum levels of Vitamin C, Thiamine and Malondialdehyde were estimated.Among the 80 patients, 17 (21%) were in septic shock. The mortality rate was 10% overall, and 47% among patients of septic shock. No additional mortality benefit was observed in the groups supplemented with Vitamin C and Thiamine. However, the ΔSOFA score in patients who received both Vitamin C and Thiamine was significantly higher as compared to the other groups. The mean malondialdehyde level was higher in patients of sepsis (1.81±1.18 µmol/l) as compared with healthy controls (0.78 ± 0.36 µmol/l). The Vitamin C level and Thiamine level (estimated indirectly by TPP effect), at presentation were 5.14±4.19 ng/ml and 52.99±28.45 % in patients of sepsis, which was significantly lower than that in healthy controls, in whom the levels were 14.64±5.51 ng/ml and 27.55±13.67% respectively.Vitamin C and Thiamine supplementation is a cost-effective approach with a good safety profile. Additional studies including a larger population is required to study the mortality benefits and reaffirm our findings.

Background: Chronic Obstructive Pulmonary Disease (COPD) is chronic inflammatory condition that is known to be a prothrombotic state. Objective: To study the prothrombotic markers and coagulation profile in patients of Stable COPD and during its exacerbation and to compare these parameters in stable phase of disease and during exacerbation. Materials and Method: A cross sectional study in which 30 patients of COPD with exacerbation and 30 patients with stable COPD were recruited. Patients having acquired thrombotic risk factors like diabetes, hypertension, coronary artery disease, chronic kidney disease, chronic liver disease, malignancy & sepsis or any immunocompromised condition along with those who were on anticoagulant therapy, statins or antihypertensive medications were excluded from the study. Levels of prothrombotic markers (von Willebrand Factor antigen, D-dimer, fibrogen) and Caogulation profile (Prothrombin time and activated Partial Thromboplastin Time) were estimated in both the groups and repeated after stabilization of exacerbation phase also. There parameters were then statistically analyzed. Observation and Results: A generalized prothrombotic state was observed in exacerbation phase of COPD as compared to stable phase of COPD. Furthermore, all the parameters including fibrinogen, vWF, PT and aPTT showed persistent declining trend from exacerbation towards stabilization. Conclusion: COPD with acute exacerbation is a state of augmented prothrombotic state. On stabilization of acute exacerbation with treatment, coagulation profile came to a level lower than that of patients in stable phase of COPD. In exacerbation phase of COPD vWF values were significantly elevated than in stable phase. How to cite this article: Daga MK, Kumar N, Singh S, Mawari G, Mahapatra SJ, Jha Mk et al. Study of Prothrombotic Markers in COPD. J Adv Res Med 2020; 7(4): 1-6. DOI: https://doi.org/10.24321/2349.7181.202014

Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of mortality and loss of Disability-Adjusted Life-Years (DALYs) worldwide. It often is accompanied by the presence of various systemic comorbidities including osteoporosis which may have an impact on the course of the disease. Osteopenia and osteoporosis are the consequences of loss of Bone Mineral Density (BMD) and have been widely known major comorbidities in COPD patients. Female sex, age, and smoking are common pathogenic factors for both COPD and osteoporosis, other factors such as reduced daily physical activity, malnutrition, low body mass index, hypogonadism, vitamin D deficiency, chronic renal insufficiency, chronic hypoxemia, and drugs like corticosteroids, have been invoked to explain such a frequent association between them. Osteoporosis in COPD is however often undertreated. It has been shown in recent studies that both decreased Bone Mineral Density (BMD) and impaired bone quality contribute to bone fragility, causing fractures in COPD patients. Pulmonary function and activities of the daily life of COPD patients may be further deteriorated by osteoporosis-associated fractures. Calcium and vitamin D, hormone replacement when indicated, calcitonin, and bisphosphonate administration are few effective strategies to tackle bone loss and osteoporosis. Awareness about this high prevalence of osteoporosis in COPD patients is critically important and physicians should look for such fracture risks. Routine screening and early diagnosis of osteoporosis will enable physicians to provide the appropriate treatment to prevent fracture, which leads to improved quality of life as well as better long-term prognosis. How to cite this article:Daga MK, Kumar N, Raghu RV, Mawari G, Chand S, Aarthi J. Osteoporosis in Chronic Obstructive Pulmonary Disease: More than just a Comorbidity. J Adv Res Med 2020; 7(3): 7-12. DOI: https://doi.org/10.24321/2349.7181.202011

Emerging and reemerging pathogens are global challenges for public health. For the third time in as many decades, a zoonotic coronavirus has crossed species to infect human populations. Given the Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) outbreak in 2002 and the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) outbreak in 2012, 2019-nCoV is the third coronavirus to emerge in the human population in the past 18 years-an outbreak that has raised great hue and cry globally as it has sickened thousands of people across the world. This novel coronavirus was named as COVID-19 which stands for Corona Virus Disease 2019. The 2019-nCoV originated from Wuhan, Hubei Province, China beginning in December 2019. The World Health Organization declared it as a Public Health Emergency of International Concern. At that point, there were 9826 confirmed cases globally, with 213 deaths. Of these, 9720 cases were in China; outside of China, health authorities reported 106 confirmed cases in 19 countries. As of February 2, the WHO updated the count, reporting 14 557 confirmed cases from 24 countries-14 411 of them in China. In this review we focus our attention on Covid-19 and how different this epidemic is from the previous two outbreak caused by coronavirus.

Background: Contamination of freshwater sources can be caused by both anthropogenic and natural processes. WHO reported that 1.1 billion people worldwide consume contaminated water, and the majority of diarrheal diseases (88%) are caused by it. According to Central Pollution Control Board (CPCB), Maharashtra along with two other states contribute 80% of hazardous waste, including heavy metal pollution in India. Certain dissolved heavy metals are easily absorbed by aquatic organisms and can enter the body through drinking water, skin absorption, and biological chains, posing a health risk. Hence, the main objectives of the study were, (1) surface and groundwater quality assessment, (2) to determine the association of diseases/symptoms with different sources of drinking water used, and (3) urinary Mercury (Hg) and Arsenic (As) levels investigation in the study population. Methods: The cross-sectional study was conducted in the industrialized city of Solapur, Maharashtra, India. The study area was limited to 25 km around the industrial hub. A total of 557 people were randomly selected for the survey, with consumers from all four types of water sources i.e., surface, handpump, wells, and municipal water. Spot urine samples were collected for estimating Hg and As levels after considering inclusion and exclusion criteria. People under treatment for tuberculosis, cancer, and chronic heart, lung, or kidney ailments were excluded. Also, pregnant and lactating women were not included. One surface water, one municipal water, and five handpump water samples were collected for evaluating water quality. Samples were analyzed for pH, Total Dissolved Solids (TDS), Dissolved Oxygen (DO), Biological Oxygen Demand (BOD), Chemical Oxygen Demand (COD), Fluoride, Ammonia, Mercury, Arsenic, Cadmium, Lead, Nickel, Copper, Zinc, Chromium, and Manganese. Results: The water samples were observed to be neutral to slightly basic. TDS was between 410 to 1898 mg/L for groundwater whereas for surface water was 378 & 450 mg/L. F concentration ranged between 0.4 to 0.9 mg/L, Zn from 0.32 to 0.57 mg/L, and NH3 was found to be

Objective To understand the pattern and types of healthcare associated infections (HAI) at our healthcare facility, and to determine the common causative agents and their antibiotic susceptibility profile. Methods One hundred consecutive patients diagnosed with HAI were enrolled and monitored; the causative organisms isolated on culture were recorded and their sensitivity profile was generated. Results Of the 100 patients diagnosed with HAI (mean age ± SD being 42 ± 17 years), there were a total of 110 hospital acquired infections with 10 patients having two infections each. Out of 100 patients with HAI, 69 patients had ventilator associated pneumonia (VAP), 21 patients had catheter associated urinary tract infection (CAUTI) patients, and 20 patients had central line associated bloodstream infection (CLABSI). There were 10 patients with both VAP and CAUTI. All of the HAIs were device associated. A total of 76 pathogens were isolated on culture. No organism was isolated in 40 HAI. Majority (94.7%) of the organisms isolated from HAIs were gram-negative bacteria and all were multidrug resistant. Seventy-seven of the enrolled patients expired while 23 were discharged from the hospital Conclusions Our study demonstrated that HAIs occur in patients of all age groups; younger patients are not spared. Majority of the HAIs were caused by multidrug resistant gram-negative bacteria and were associated with high patient mortality. Acinetobacter species was the most common organism associated with HAI.

Ever since the WHO's declaration of the SARS-CoV-2 pandemic, the medical literature has been focusing upon the patterns of association of SARS-CoV-2 with different diseases. Patients with Osler-Weber-Rendu Syndrome, also known as, Hereditary hemorrhagic telangiectasia (HHT), presents with recurrent epistaxis, nostril manipulations, incidental detection of multiple AVMs (Arterio-Venous Malformations), and telangiectasias over mucocutaneous tissues and internal organs. In addition, these AVMs are prone to bleed or act as a nidus for thrombus formation apart from other serious complications like chronic hypoxemia, anemia, pulmonary artery hypertension, heart failure, and cerebrovascular disease accidents. Here, we provide a case report of such a patient who was diagnosed with HHT as per 'Curaçao criteria'; having a history of multiple episodes of epistaxis, radiological evidence of AVMs over left calf, pulmonary and hepatic region, multiple telangiectasias in the splenic region and uterine vascular malformations. Upon acquiring severe COVID-19 infection, the patient developed complications like anemia, pulmonary artery hypertension, sepsis, acute kidney injury, and post COVID-19 persistence of type1 respiratory failure. Moreover, the risk-benefit ratio of anticoagulation therapy in such patients with COVID-19 infection is tricky and challenging; however, our patient was prophylactically anti-coagulated with enoxaparin for 12 days with an uneventful outcome. Keywords: Osler-Weber-Rendu Syndrome, Hereditary hemorrhagic telangiectasia, HHT, Prophylactic Anticoagulation, Covid-19, SARS-CoV-2.

Background: COPD being a systemic inflammatory disease is accompanied by alteration of various inflammatory cytokines which affect the metabolic equilibrium of body. Some therapeutic options, mainly statins via their wide range of pharmacologic actions alter the level of proinflammatory cytokines hence, helpful in attenuating various extra-pulmonary consequences of COPD. We did a randomised case-control study to study the effect of statin supplementation on pulmonary function and inflammatory markers in patients of COPD. Methods: We included 40 stable COPD subjects & randomized them in two groups, Intervention & Non-intervention. Intervention group received 40 mg atorvastatin once daily for 3 months in addition to the conventional treatment of COPD similar to the prior one. We studied levels of IL-6 & CRP and correlated them with disease severity before and after the aforementioned intervention. Results: We observed that CRP levels decreased in both the groups after a follow up of 3 months, but neither of them was statistically significant (p=0.57 & 0.63 respectively) nor the mean of their difference (p=0.969). IL-6 levels showed a persistent decline in intervention group but, was not significant (p=0.91). In this study, we noticed statistically significant improvement in FEV1 (p=0.008) in the intervention group which was in contrast to non-intervention group. Similarly, the exercise capacity also statistically increased in the intervention group (p=0.002). There was also evident negative correlation between exercise capacity and IL-6 as well CRP levels. FEV1 also showed statistically significant negative correlation with IL-6 levels (p=0.023). Conclusion: We can improve the disease outcome and alter its natural progression by altering the levels of inflammatory markers with the aid of some additional pharmacological interventions i.e., in this study was atorvastatin.

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is responsible for global pandemic, and it has caused more than 2.3 million deaths. Persistence and stability of immunoglobulin G (IgG) response after recovery from COVID-19 infection is still uncertain. MethodsWe performed a longitudinal cohort study in healthcare workers (HCW) and their close contacts (Non-HCW) with known resolved SARS-CoV-2 infection and undiagnosed infection at Maulana Azad Medical College and associated Lok Nayak hospital, New Delhi. Baseline IgG antibody titers was determined and the participants were followed over a period of six months. We also examined relationship between SARS-CoV-2 immunoglobulin G (IgG) response and new symptomatic infection in HCW and Non-HCW over time. Results176 (70.9%) healthcare workers and 72 (29.0%) non-healthcare workers were recruited from two cohorts. 82 subjects recovered from SARS-CoV-2 infection and 166 undiagnosed for the infection having history of close contact with COVID-19 patients were followed up for a median of 227 days (interquartile range, 166 to 202) after a positive IgG antibody test. In the recovered subjects 70.7% (58) were seropositive for first anti-spike IgG assay at baseline, followed by 80.0%, 90.6% and 82.6% at three visits respectively. In undiagnosed subjects 37.3% (62) were seropositive at baseline, followed by 70.9%, 75.8% and 82.2% respectively. Also, 46.8% (29) were asymptomatic with no symptoms of COVID-19 and were seropositive at baseline. However, presence of IgG antibodies was associated with substantial reduced risk of re-infection over the follow up duration.ConclusionOur data showed that the antibodies levels measured increased over the first three months and decreased slightly after that and remained at a plateau and relatively stable for at least a period of six months.

Aims and objectives Serum adrenomedullin (ADM) as a prognostic biomarker to study the gender-related differences in mortality pattern and its correlation with the sequential organ failure assessment (SOFA) and acute physiologic assessment and chronic health evaluation II (APACHE II) scores in patients of sepsis. Measurements and main results Eighty patients of sepsis of which 36 were males and 44 were females, were taken in the study as per sepsis III guidelines. They were followed up for a period of 28 days. Serum ADM was measured on day 1 and day 5. The endpoint was mortality or survival at day 28 after admission. The death rate among males was higher, with 23 of the total 36 (63.89%) patients having died when compared with females in which 25 patients out of 44 (56.82%) had died. The observed mortality rates correlated well with average APACHE II scores. The average APACHE II score was slightly higher in males (29 ± 8.97) when compared with females (27.02 ± 8.69). Similarly, day 1 SOFA and mean SOFA values were higher in males (10.22 ± 5.36) and (10.73 ± 6.01) when compared with females (8.27 ± 4.79) and (8.89 ± 5.6), respectively. Males despite having higher mortality rates, higher APACHE II, SOFA, and mean SOFA values were still having less mean levels of serum ADM (454.40 ± 81.13 pg/mL) when compared with females (479.62 ± 126.97 pg/mL). Conclusion Adrenomedullin is a protective neurohormone with antibacterial and anti-inflammatory properties. It is elevated in all patients with sepsis but the rise is more so in the female when compared with males. Higher ADM levels in females may suggest the protective effect of ADM as a part of the general protective neurohormonal stress response, which may explain the low death rate in females in sepsis. How to cite this article Daga MK, Kumar L, Mawari G, Kumar N, Singh S, Mishra TK. Adrenomedullin and Its Possible Role in Improved Survival in Female Patients with Sepsis: A Study in the South East Asian Region. Indian J Crit Care Med 2020;24(12):1180–1184.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the causative organism for Coronavirus Disease 2019 (COVID-19), originated in Wuhan, China and has now spread to most parts of the world. A pandemic of this magnitude has not been witnessed in more than 100 years since the Spanish flu in 1918. The major challenge for scientists and doctors worldwide has been to find a therapeutic intervention to prevent the spread and development of this disease. As more research is being done, the pathophysiology of COVID-19 has been explained, although no effective therapy has been found. Multiple drugs and therapies are under trials and a few have shown inconclusive results. The attempts have ranged from repurposing drugs to trying to develop new vaccines. Formulation of guidelines pose another challenge to the government and international agencies owing to the lack of data. These agencies have constantly released and updated guidelines based on new research and growing knowledge. In this review, we aim to compare and bring out the different international guidelines for management of COVID-19, along with a review of tried therapeutic interventions and their primitive results. The COVID-19 has been a major global health crisis that is overpowering most heath care systems and multiple agencies and research teams are trying to limit and manage this spread. Currently no effective treatment is available and guidelines differ regarding the drugs that can be used, which are mostly off-label.

nCOVID-19 (2019 novel corona virus) is a naive infective virus that brought the whole world to standstill. The clinical features attributing to its infection have a broad spectrum, ranging from minimally symptomatic to respiratory failure and death. The aim of present case series was to assimilate data regarding the clinical characteristics of first 11 cases of COVID-19 infection in the local population of Andaman and Nicobar Islands. Various clinical features, biochemical and individual parameters were compiled that may affect the disease evolution and then, subjected to descriptive analysis. Out of 11 patients, six patients had a definitive known source of their infection and four patients had history of close contacts with first six ones. Only one patient had unknown source of the infection. Majority of the patients remained asymptomatic to pauci-symptomatic. Mean duration of symptomatic period was less than seven days (5.6 days). In this series, out of 11 patients, 2 (18%) were females and rest all were males (82%). Four of the patients had fever, four had cough and four had weakness and fatigue, two had malaise, three had anorexia, one had dyspepsia and one diarrhea. None of the patient landed in Intensive care unit (ICU). Patients were treated with empirical combination therapy including Azithromycin (500 mg OD) and Oseltamivir (75 mg BD) irrespective of their symptoms. Additionally, Hydroxychloroquine (200 mg BD) was given to symptomatic ones. Conclusively, less dreadful clinical presentation of this infection was faced in this population.

The outbreak of coronavirus disease 2019 (COVID-19) wreaked havoc all across the world, claiming numerous casualties. Managing the pandemic has resulted in the production of an unprecedented volume of biomedical waste (BMW), in the form of used personal protective equipment (PPE), diagnostic items, etc. It is a matter of utmost urgency that this BMW is treated, using newer and environmentally sustainable methods as compared to the available ones. The inadequacies of the conventional methods of bio medical waste management call for newer and sustainable alternatives for management like simple greenhouse containers, pyrolysis of polypropylene PPE, usage of silk masks, development of novel biodegradable masks, Antimicrobial Photodynamic therapy (aPDT), nano-photocatalysts, etc. These methods have numerous advantages over currently used methods like incineration, landfilling, etc., and can sustainably be used as an adjunct or an alternative to them.

Background: Chronic obstructive pulmonary disease (COPD) has a major impact on health status in accordance with disease severity. It is usually assessed by the various quality of life questionnaires. Objectives: The aim of this study is to assess the disease severity and health status in stable patients of COPD using COPD assessment test (CAT) and clinical COPD questionnaire (CCQ) scores and to correlate with BODE index and its components. Methods: One hundred patients of stable COPD were subjected to CAT, CCQ irrespective of the stage of COPD during their visit. BODE index was also calculated. Results: COPD severity status assessed using forced expiratory volume 1% (FeV1%) predicted values correlated significantly with individual scores (CAT and FeV1%; r = −0.67; P < 0.001 and CCQ and FeV1%; r = 0.61; P < 0.001). CAT and CCQ score also correlated significantly (r = 0.84, P < 0.001) and both with the BODE index (r = 0.80; CAT and r = 0.66; CCQ, P < 0.01). Individual components of BODE index significantly correlated with CAT and CCQ scores. Conclusions: The CAT and CCQ have similar psychometric as well physical properties to assess the health status of COPD patients and can be used as a reliable scientific research tool and can be used in clinical practise to study the disease state and plan an appropriate treatment plan. The BODE index which is more objective, correlated well.

Background The achievement of optimal results out of total knee arthroplasty surgery depends on fit and sizing of the implant over the bone. Mismatch between resected bone and implant alters the outcome of the surgery. Identifying the medial-lateral and anterior–posterior measurement in the resected femur lays the foundation for identifying the implant size. The ratio of medial-lateral and anterior–posterior measurement figures out the match between implant and bone. The bony architecture is influenced by ethnicity. Therefore it becomes essential to study distal bone notability from different indigenous origin groups. Questions/purposes This study incorporates a systematic review analysis of the English literature published on the anthropometric dimensions of the distal femur. The anterior–posterior and medial-lateral width values are assessed to determine the inherent ethnic differences in bony parameters. Methods An extensive search in seven search engines was performed to produce 9820 responses. This collection was imported in endnote library to finally obtain 6320 publications after duplication. Further detailed examination produced only 65 papers to undergo full-text inspection. After a thorough review of the full text, only 20 papers were found to be relevant for a systematic review. Results There were 8 different racial populations assessed in the various studies. Caucasians were studied by most of the authors. All papers imply the need of alterations in the current implant sizing to improve fitment in Asian population. Conclusions Most of the studies were performed with patients of Caucasian origin. The Asian sub-populations studies demonstrated the incongruence in implant sizing and anthropometric measures and therefore recommending that these ethnic differences need to be addressed in future implant design.

Majority hospital admission in COVID-19 is because of pneumonia. Few develop progressive and permanent pulmonary fibrosis. Here, we present three patients of severe COVID-19 pneumonia requiring intensive care unit care. Computed tomography (CT) of the chest of these patients revealed multiple areas of lung involvement at the 4th week of illness. Follow-up CT scan and pulmonary function test were done after 5 months to look for residual changes. Pulmonary fibrosis induced by COVID-19 is being documented. We need long-term follow-up studies to observe the clinical and radiological course of fibrosis. Corticosteroids and antifibrotic agents in such cases are being looked into.

Emerging and reemerging diseases pose global challenges for public health. Pneumonia of unknown origin, given the name COVID-19, began in China in December 2019. On March 11, 2020, the WHO declared it to be a pandemic. Currently, the disease is booming rapidly and impacting the well-being of people and the economy of countries globally. Observational studies have somewhat highlighted clinical findings of the disease, but there are still no decisive data about its global trends. The purpose of this review is to bring to light the huge disparities in the clinical presentation of the disease among countries. The data for this review were obtained from studies pertaining to clinical, laboratory, and imaging features obtained from various journals. It was found that occurrence of the most frequently seen features ranged as – fever (98%–35%), cough (88%–25%), dyspnea (88%–4.8%), and sore throat (61%–8%). A definite reason for this is still obscure. This calls for more conclusive studies to investigate the possible causes of these trends. This might go a long way in increasing our understanding of the disease and improve its diagnosis and treatment.

Chronic obstructive pulmonary disease (COPD) is characterized by irreversible airflow limitation and is associated with weight loss and decreased muscle strength and exercise capacity.A double-blinded randomized controlled trial of 32 male COPD patients (age, 54.94 ± 11.27 years) was carried out to assess effects of anabolic steroid in terms of a daily high-protein, high-calorie diet alone or one combined with anabolic steroids on body composition, lung function, and health-related quality of life (HRQL). Outcomes were assessed by anthropometric and spirometric measurements, peak expiratory flow rate, partial pressure of oxygen in arterial blood, 6-minute walk test (6MWT), hand grip test, and HRQL index scores. Measurements were made at baseline and end of treatment (6 weeks).All patients showed significant difference (P.001) in pulmonary function parameters and anthropometric measurements after 6 weeks of intervention (within-group changes); however, no significant improvement occurred in the pulmonary function parameters between the groups. The difference in exercise capacity (6MWT) and HRQL scores in the treatment group were statistically significant (P.001) compared with control group after 6 weeks of intervention. In the treatment group, the average 6MWT distance increased from 213.5 m to 268.5 m at 6-week follow-up, and HRQL scores increased from 101.25 to 118.45. Also, HRQL and 6MWT parameters were positively correlated in response to steroid supplementation at the end of the study.Weekly administration of anabolic steroids during 6 weeks increased exercise capacity and quality of life in patients with COPD.

Introduction: The health impact of air pollution caused by firecrackers used during festival time is an area of great concern in Indian population. Trapping of pollutants due to burning of firecrackers during Diwali and Dusshera festivals promotes the formation of smog, which leads to raise in respirable suspended particulate matter (RSPM) and SPM values above the standard values. Aim: This study was designed to assess the air quality pre- and post-Diwali and Dusshera in North India and also to find out the exposure effect of poor air quality on the health of population as well as health risk assessment of the population. Materials and Methods: A total of 470 individuals of different age groups were interviewed during Dusshera festival (i.e., both pre- and post-Dusshera) in four chosen areas. Besides, 788 individuals of different age groups were interviewed during Diwali festival (i.e., both pre- and post-Diwali) in the same four areas. A total of 223 individuals also underwent pulmonary function testing (portable spirometry) on a random basis (fifty in each area, 3 days before and after Diwali). Results: The comparison of respiratory disease complaints pre- and post-Diwali showed that there was a significant increase in the complaints of cough post-Diwali among the participants of Kotla (6.7% vs. 28.9%). However, there was a significant decrease in cough and breathlessness post-Diwali in Parivesh Bhawan. The ambient air quality of three residential areas was within normal limits both pre- and post-Diwali with respect to sulfur dioxide and nitrogen dioxide, but there was an increase in the levels of PM10 and PM2.5 post-Diwali. Conclusion: The level of suspended particles in the air increases alarmingly which can be associated with eye, respiratory, and allergic problems. Crackers and fireworks were found to be the chief sources of air pollution during festivals in India. Even though the impact of Diwali is short term, the short-term exposure of these pollutants in the environment affects the standard values of air particulate and can cause health complications.

Naushad Ahmad Khan,1,2 Mradul Kumar Daga,1 Istaq Ahmad,2 Govind Mawari,1 Suman Kumar,3 Naresh Kumar,1 Syed Akhter Husain2 1Department of Medicine, Maulana Azad Medical College, 2Department of Biosciences, Jamia Millia Islamia, 3Department of Microbiology, MaulanaAzad Medical College, NewDelhi, India Introduction: BODE index, a multidimensional grading system which is based on Body mass index, airway Obstruction, Dyspnea scale, and Exercise capacity, has been increasingly used for the evaluation of chronic obstructive pulmonary disease (COPD). Many of the systemic manifestations of COPD are shown to be mediated by elevated levels of proinflammatory biomarkers.Objective: We aimed to investigate the relationship between the BODE index, its components, disease severity, and proinflammatory biomarkers like C-reactive protein (CRP), tumor necrosis factor (TNF)-α, and interleukin (IL)-6.Materials and methods: A cross-sectional study which included 290 clinically stable COPD patients and 80 smoker controls was conducted. Medical history, body mass index, pulmonary function tests, 6-minute walking test, and modified scale of Medical Research Council dyspnea scale were evaluated. BODE scores were determined. Systemic inflammation was evaluated with the measurement of CRP, TNF-α, and IL-6 in the serum samples of all studied subjects. The correlation between inflammatory biomarkers and BODE index was assessed in COPD patients.Results: We found a significant relationship between COPD stages and BODE index. Our analysis showed significant association between systemic biomarkers and components of the BODE index. Both TNF-α and CRP levels exhibited weak but significant correlation with BODE index. Serum IL-6 concentrations exhibited significant correlation with 6-minute walking test, modified scale of Medical Research Council, and BODE index (r=0.201, P=0.004; r=0.068, P=0.001; and r=0.530, P=0.001, respectively). Also, an inverse and significant correlation was observed between BODE index and FEV1 (r=0.567, P=0.001). IL-6 exhibited a highly significant and inverse correlation with FEV1 (r=−0.580, P=0.001).Conclusion: BODE index should be considered for evaluating patients with COPD. Also, IL-6 seems to be a potential biomarker that may enable determination of the severity and prediction of the course of the disease. Keywords: BODE index, chronic obstructive pulmonary disease, systemic inflammation, biomarkers

Background: Statins have anti-inflammatory effects in patients with COPD. This may lead to reduction in production of proinflammatory cytokines. Aims: The study aimed to evaluate the effects of statin on serum hs-CRP, IL-6 levels and pulmonary function in patients with COPD. Materials and Methods: Twenty Participants were block randomized to receive 40mg Atrovastatin/day in addition to conventional treatment (Intervention group) and rest 20 patients received only conventional treatment (Non Intervention group). Pulmonary function test, 6 min walk distance test and BODE Index were measured. Serum IL-6 and hsCRP levels were measured by ELISA method. All these parameters were repeated after 03 months . Results: The difference between baseline and 03 months was calculated for both groups in term of serum hs-CRP, IL-6, FEV1, 6MWD and BODE Index. No significant improvement was observed between both the groups in the hsCRP levels at the baseline ( p =0.57) and after 03 month (p=0.63).However, a significant decrease in IL-6 levels (24.06±4.46 to 12.78± 2.41, p=0.001) , FEV1 (38.5±16.7 to 43.12±18.75; p=0.001), exercise capacity (6MWD=566.53±41.5 to 714.02± 45.9, p=0.002), and BODE Index (3.95±1.9 to 4.65±2.28, p=0.019) respectively was found after 03 months in the intervention group. No significant improvement was observed in control group for the above mentioned variables. Conclusion: Atorvastatin Supplementation does not seem to alter hsCRP levels. However it does lead to a significant decrease in IL-6 Levels as compared to conventional therapy. Also, it might contribute to improvement in pulmonary function, exercise capacity and BODE Index in patients with COPD.