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Context Coronavirus disease 2019 (COVID-19), an infection involving the respiratory system caused by severe acute respiratory syndrome coronavirus 2, caused significant mortality and morbidity in the population. Certain studies showed that patients with cardiovascular diseases (CVDs) tend to have worse prognoses. Hence, this study was conducted to determine the role of CVD as a risk factor in COVID-19 disease. Objectives The primary objective was to determine the CVD as a risk factor for death among COVID-19 patients. Materials and Methods This retrospective cohort study was conducted in a tertiary care hospital in South India including all patients above 18 years of age who were admitted with COVID-19 disease in the hospital from March 2021 to June 2022. The data were retrieved from the medical records department of the hospital and were recorded in a predesigned data extraction sheet. Statistical Analysis Used Baseline clinical characteristics were shown as mean (standard deviation), median (range), or number (%), with a comparison of characteristics in subjects stratified by case and control through the nonparametric Mann–Whitney U test for continuous variables and Chi-square or Fisher’s exact test for binary variables. Results The study included 1127 COVID-19 patients, 86.2% were discharged, and 13.8% died. Patients aged over 60 years were hospitalised the most (53.2%), with a 16.2% mortality rate. Mild cases (62.9%) had a 2.96% mortality rate, whereas severe/intensive care unit (ICU) cases (10.5%) had a 65.3% mortality rate. Patients with preexisting CVD had a higher mortality rate (32.27%) compared to those without CVD (6.53%). Among specific CVD conditions, coronary artery disease (CAD) patients had a 15.07% mortality rate, while those without CAD had a 13.58% mortality rate, showing no significant difference. Patients with hypertension (HTN) (45.7%) and diabetes (53.2%) had higher mortality rates of 17.08% and 16.66%, respectively, compared to those without these conditions. Other factors such as angina, congestive heart failure, peripheral vascular disease, cerebrovascular accidents (CVA), and chronic kidney disease also showed varying impacts on patient outcomes. Conclusions In our study, 972 (86.2%) patients were discharged and 155 (13.8%) patients were deceased. There was more mortality in male patients (15.4%). Mortality was more in patients

This study was designed to obtain the maximum extraction yield of peanut shell (PS) polyphenols using a novel carbon dioxide nanobubbles (CO2-NBs) assisted ultrasonic extraction method. CO2-NBs were generated in distilled water with a self-developed high-pressure nano-jet homogenization method and characterized by size, zeta potential and transmission electron microscopy (TEM). The obtained nanobubble’s mean size and zeta potential were 229.96 ± 17.44 nm and −15.9 ± 1.27 mV, respectively. Later, these CO2-NBs, combined with ultrasonic method, were used for the extraction of polyphenols, achieving the highest polyphenol content (3619.21 ± 113.07 µg GAE/mL) as compared to ultrasonic extraction (2914.69 ± 145.45 µg GAE/mL) and conventional extraction (2340.11 ± 80.02 µg GAE/mL). Response surface methodology (RSM) provided optimization parameters, including ultrasonic power of 358.76 W, surfactant concentration of 4.54 %, and extraction time of 41.41 min. HPLC analysis identified distinct peaks corresponding to polyphenolic compounds such as gallo-catechin, catechin gallate, resveratrol, and luteolin, confirming their presence and concentrations in the peanut shell extract (PSE). Scanning electron microscopy (SEM) revealed significant structural disruption and increased porosity in peanut shell powder, supporting the enhanced extraction of polyphenols through CO2-NBs-assisted ultrasonic extraction process. This research establishes theoretical and practical foundation for generation of CO2-NBs and CO2-NBs ultrasonic extraction technology to efficiently extract polyphenols from waste PS, thereby enhancing the extraction efficiency of valuable compounds for use in functional food products and promoting sustainable practices in food industry.

Background: Intracerebral hemorrhage (ICH) accounts for around 10% to 20% of all stroke cases worldwide. It is one of the most fatal and disabling subtype of strokes. Volume of hemorrhage is well documented risk factor for mortality. Aims and Objectives: The objectives of this study is to find whether the location of ICH is an independent risk factor for morbidity and mortality. Material and Methods: It is a prospective cohort study involving adult patients with age more than 18 years presenting with ICH. All patients satisfying inclusion criteria were subjected to CT scan brain. The location of hemorrhages and volume were noted. The four independent variables – gender, presence of hypertension, location and volume of bleed were documented. Their association with modified Rankin scale was calculated using chi – square test, the significance was calculated with P < 0.05. Result: Eighty patients were recruited in the study. 72.5% were male and 27.5% were female. Mean age was 56.25 + 14.3 years. Hypertension was one of the commonest risk factor for ICH (80%). Volume of bleed more than 60 cc was associated with 100% mortality. The majority of the patients presented with ganglio – capsular hemorrhage (64%). Cerebellar and lobar hemorrhage had mortality of 66.7% and 100% respectively. The volume of bleed had odds ratio of 1.2 (P < 0.05). The logistic regression analysis adjusting location of bleed for volume was not significant (P = 0.47). Conclusion: Hypertension is one of the commonest risk factor for ICH. The volume of bleed is an independent predictor of mortality irrespective of location of hemorrhage, gender and other co-morbidity.

Background: Type 2 diabetes mellitus is one of the leading causes for global public health crisis mainly affecting the Asian countries. Cardivascular disease (CVD) is one of the leading contributors to morbidity and mortality for type 2 diabetes mellitus patients. Assessment of the cardiovascular risk in asymptomatic patients and advising them for proper preventive measures will help to bring down the morbidity and mortality. In this study we aim to find the correlation of carotid intima thickness (CIMT) with different risk scores estimating 10 years risk of cardiovascular disease. Method: It is a cross sectional study involving type 2 diabetes mellitus patient of age between 20 years and 80 years, without having any previous history of cardiovascular disease, cerebrovascular accident, chronic kidney disease and connective tissue disorder. Detailed history and examination was done along with blood investigations like fasting lipid profile, HbA1c, fasting and post prandial blood glucose, blood urea and creatinine. All these data were used to estimate 10 years cardiovascular risk using different risk engines - United Kingdom Prospective Diabetes Study (UKPDS) risk engine, Framingham Risk Score (FRS), Q risk and Atherosclerotic cardio vascular disease (ASCVD). All the patients were subjected for measurement of carotid intima thickness (CIMT) by ultrasonography. Correlation coefficient was calculated using SPSS software version 18. Result: Total 59 patient (40 males and 19 females) were included in the study. Mean age, duration of diabetes, HbA1c and CIMT were 56.3 ± 10 years, 8.1 ± 6.9 years, 8.2 ± 1.2% and 0.8 ± 0.2 mm respectively. Age, duration of diabetes, HbA1c, total cholesterol, low density cholesterol and triglyceride had significant positive correlation with CIMT (P < 0.05). Among risk score ASCVD, Q risk and UKPDS risk score had positive and significant correlation with CIMT (P < 0.05). Although, FRS had positive correlation, it was not statistically significant. Conclusion: In the absence of South Asian specific risk estimate algorithm Q risk and UKPDS risk score can be used with caution. CIMT is well established indicator of atherosclerosis, hence it can be used to estimate cardiovascular risk and to advise preventive measures.

Introduction Investigate the effects of switching from two times per day exenatide to once-weekly exenatide administered by autoinjector (exenatide once-weekly suspension by autoinjector (QWS-AI)) or treatment with exenatide QWS-AI for 1 year.Research design and methods In this phase III open-label study, adults with type 2 diabetes were randomized to receive exenatide QWS-AI (2 mg) or exenatide two times per day (5 mcg for 4 weeks, followed by 10 mcg) for 28 weeks. During a subsequent non-randomized 24-week extension, patients who received exenatide two times per day were switched to exenatide QWS-AI and those randomized to exenatide QWS-AI continued this treatment. Efficacy measures included changes from baseline in glycated hemoglobin (A1C), fasting plasma glucose (FPG), and body weight.Results In total, 315 patients (mean baseline A1C of 8.5%) completed the initial 28 weeks of randomized treatment with exenatide QWS-AI (n=197) or exenatide two times per day (n=118) and were included in the 24-week extension (mean A1C of 7.0% and 7.3%, respectively, at week 28). From weeks 28–52, patients who switched from exenatide two times per day to exenatide QWS-AI had additional A1C reductions of approximately 0.5% (mean A1C change from baseline of –1.4% at week 52) and further reductions from baseline in FPG. Patients who continued exenatide QWS-AI treatment for 52 weeks showed clinically relevant A1C reductions (mean A1C change from baseline of –1.3% at week 52). Body-weight reductions achieved through week 28 were sustained at week 52 in both groups. There were no unexpected safety concerns or changes in the safety profile among patients who switched from exenatide two times per day to exenatide QWS-AI or those who continued exenatide QWS-AI treatment for 52 weeks.Conclusions Switching from exenatide two times per day to exenatide QWS-AI resulted in further A1C reductions and maintenance of earlier decreases in body weight, while continued therapy with exenatide QWS-AI for 52 weeks maintained A1C and body-weight reductions, without additional safety or tolerability concerns.Trial registration number NCT01652716.

Background: The toxicity due to lead is a widely researched sphere of public interest. Positive associations have been identified between lead exposure and coronary heart disease and cardiac rhythm disturbance. This study has been undertaken in general population to determine whether the blood lead level has any role in cardiovascular disease. Aims and Objectives: To estimate the blood levels in young patients with Myocardial Infarction and compare with the older patients. Settings and Design: A descriptive cross-sectional study was conducted among 100 patients with Myocardial Infarction [MI] admitted in a private medical college over a Study Period of 12 months categorized into 2 groups of 50 each based on age 45 yrs. Materials and Methods: Patients with ECG changes suggestive of Myocardial Infarction and elevated CKMB and Troponin I were included and patients with other than the conventional risk factors were excluded. Patients were further investigated for complete blood count, fasting lipid profile, serum electrolytes, 2D echocardiograph, CK-MB, Troponin I and blood lead levels. Results: The prevalence of MI was 94% and 8% in men and women of the younger group whereas 74% in men and slightly higher percentage of 26% in women of the older group. The mean blood lead levels was 8.392 mg/dl with a standard deviation of 4.5 mg/dl among younger patients as compared to mean of 15.048 mg/dl with standard deviation of 2.5 mg/dl indicating a significant increase in blood lead levels as the age progresses, though the lead levels were in normal range. Conclusion: The study revealed a significant correlation of serum lead concentration with progression of age, though no such correlation was found with Myocardial Infarction. However further studies with healthy participants, larger sample size and data in regards to specific occupation, life style and geographic location can yield significant results to attribute serum lead as a risk factor for developing cardiovascular disease.

Abstract Background In the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients with Diabetes Mellitus (SAVOR) trial in patients with type 2 diabetes mellitus (T2D) at high risk of cardiovascular (CV) disease, saxagliptin did not increase the risk for major CV adverse events. However, there was an unexpected imbalance in events of hospitalization for heart failure (hHF), one of six components of the secondary CV composite endpoint, with a greater number of events observed with saxagliptin. Here, we examined findings from nonclinical safety and clinical pharmacology studies of saxagliptin with the aim of identifying any potential signals of myocardial injury. Methods In vitro and in vivo (rat, dog, monkey) safety pharmacology and toxicology studies evaluating the potential effects of saxagliptin and its major active metabolite, 5-hydroxy saxagliptin, on the CV system are reviewed. In addition, results from saxagliptin clinical studies are discussed: one randomized, 2-period, double-blind, placebo-controlled single-ascending-dose study (up to 100 mg); one randomized, double-blind, placebo-controlled, sequential, multiple-ascending-high-dose study (up to 400 mg/day for 14 days); and one randomized, double-blind, 4-period, 4-treatment, cross-over thorough QTc study (up to 40 mg/day for 4 days) in healthy volunteers; as well as one randomized, placebo-controlled, sequential multiple-ascending-dose study in patients with T2D (up to 50 mg/day for 14 days). Results Neither saxagliptin nor 5-hydroxy saxagliptin affected ligand binding to receptors and ion channels (e.g. potassium channels) or action potential duration in in vitro studies. In animal toxicology studies, no changes in the cardiac conduction system, blood pressure, heart rate, contractility, heart weight, or heart histopathology were observed. In healthy participants and patients with T2D, there were no findings suggestive of myocyte injury or fluid overload. Serum chemistry abnormalities indicative of cardiac injury, nonspecific muscle damage, or fluid homeostasis changes were infrequent and balanced across treatment groups. There were no QTc changes associated with saxagliptin. No treatment-emergent adverse events suggestive of heart failure or myocardial damage were reported. Conclusions The saxagliptin nonclinical and clinical pharmacology programs did not identify evidence of myocardial injury and/or CV harm that may have predicted or may explain the unexpected imbalance in the rate of hHF observed in SAVOR.

Posterior reversible encephalopathy syndrome (PRES) is a clinical and radiographical syndrome of varying etiologies. It is characterized by headache, confusion, seizures, visual loss, and raised blood pressure along with magnetic resonance imaging abnormalities. It is associated with a number of conditions such as hypertension, eclampsia, vasculitis, chemotherapeutic drugs, and postpartum state. We report the case of a 28-year-old female who developed PRES on her 8th day of postpartum along with subarachnoid hemorrhage.

Software products in the market are changing due to changes in business processes, technology, or new requirements from the customers. Maintainability of legacy systems has always been an inspiring task for the software companies. In order to determine whether the software requires maintainability by reverse engineering or by forward engineering approach, a system assessment was done from diverse perspectives: quality, business value, type of errors, etc. In this research, the changes required in the existing software components of the legacy system were identified using a supervised learning approach. New interfaces for the software components were redesigned according to the new requirements and/or type of errors. Software maintainability was measured by applying a machine learning technique, i.e., Naïve Bayes classifier. The dataset was designed based on the observations such as component state, successful or error type in the component, line of code of error that exists in the component, component business value, and changes required for the component or not. The results generated by the Waikato Environment for Knowledge Analysis (WEKA) software confirm the effectiveness of the introduced methodology with an accuracy of 97.18%.

Background In the EXSCEL (Exenatide Study of Cardiovascular Event Lowering), exenatide once‐weekly resulted in a nonsignificant reduction in major adverse cardiovascular events (MACEs) and a nominal 14% reduction in all‐cause mortality in 14 752 patients with type 2 diabetes mellitus (T2DM) with and without cardiovascular disease. Whether patients at increased risk for events experienced a comparatively greater treatment benefit with exenatide is unknown. Methods and Results In the EXSCEL population, we created risk scores for MACEs and all‐cause mortality using step‐wise selection of baseline characteristics. A risk score was calculated for each patient, and a time‐to‐event model for each end point was developed including the risk score, treatment assignment, and risk‐treatment interaction. Interaction P values evaluating for a differential treatment effect by baseline risk were reported. Over a median follow‐up of 3.2 years (interquartile range, 2.2, 4.4), 1091 (7.4%) patients died and 1744 (11.8%) experienced a MACE. Independent predictors of MACEs and all‐cause mortality included age, sex, comorbidities (eg, previous cardiovascular event), body mass index, blood pressure, hemoglobin A1c, and estimated glomerular filtration rate. The all‐cause mortality and MACE risk models had modest discrimination with optimism‐corrected c‐indices of 0.73 and 0.71, respectively. No interaction was observed between treatment effect and risk profile for either end point (both interactions, P>0.1). Conclusions Baseline characteristics (eg, age, previous cardiovascular events) and routine laboratory values (eg, hemoglobin A1c, estimated glomerular filtration rate) provided modest prognostic value for mortality and MACEs in a broad population of patients with type 2 diabetes mellitus. Exenatide's effects on mortality and MACEs were consistent across the spectrum of baseline risk. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01144338.

Background Concurrent infection with multiple pathogens is common in tropics, posing diagnostic and treatment challenges. Although co-infections of dengue, malaria, leptospirosis and typhoid in various combinations have been described, data on dengue and scrub typhus co-infection is distinctly limited. Methodology This was a retrospective analysis of dengue and scrub typhus co-infection diagnosed between January 2010 and July 2014 at a tertiary care center. Clinical and laboratory features of these cases were compared with age and gender matched patients with isolated dengue fever and isolated scrub typhus. Positive test for dengue non-structural 1 (NS1) antigen was considered diagnostic of dengue whereas scrub typhus was diagnosed by IgM scrub antibodies demonstrated by ELISA. Results There were 6 cases of dengue-scrub co-infection during the review period which fitted clinical and laboratory profile with a mean age of 42.5 years. Fever, headache and arthralgia were common. Normal haemoglobin, significant thrombocytopenia, transaminitis and hypoalbuminemia were identified in these patients. Compared to patients with isolated dengue, those with co-infection had higher pulse rate, lower systolic blood pressure, normal leucocyte counts, higher levels of liver enzymes, greater prolongation of partial thromboplastin time (aPTT) and lower serum albumin. Co-infection was characterized by a lower nadir platelet count compared to scrub typhus, and lesser time to nadir platelet count and longer duration of hospital stay compared to either isolated dengue or scrub typhus. Conclusion Dengue-scrub typhus co-infection may be under-diagnosed in tropics, particularly confounded during dengue epidemics. Normal leucocyte counts, early drop in platelets and hypoalbuminemia in dengue patients could be clues to concurrent scrub typhus infection. Prompt recognition and treatment of scrub typhus in such cases may reduce unnecessary hospital stay and cost.

Nayyar IqbalDepartment of Medicine, Division of Endocrinology, Diabetes and Metabolism, University of Pennsylvania, Philadelphia VA Medical Center, PA, USAAbstract: Type 2 diabetes is widespread and its prevalence is increasing rapidly. In the US alone, approximately 41 million individuals have prediabetes, placing them at high risk for the development of diabetes. The pathogenesis of type 2 diabetes involves inadequate insulin secretion and resistance to the action of insulin. Suggestive data link insulin resistance and accompanying hyperglycemia to an excess of abdominal adipose tissue, a link that appears to be mediated partially by adipocyte secretion of multiple adipokines that mediate inflammation, thrombosis, atherogenesis, hypertension, and insulin resistance. The adipokine adiponectin has reduced expression in obesity and appears to be protective against the development of type 2 diabetes. Current recommendations to prevent type 2 diabetes center on lifestyle modifications, such as diet and exercise. Clinical trials have established the efficacy of lifestyle intervention, as well as pharmacologic interventions that target glycemic control or fat metabolism. However, diabetes did develop in a substantial percentage of individuals who received intensive intervention in these trials. Thus there is an unmet need for additional strategies in high-risk individuals. Recent data suggest thiazolidinediones and blockade of the endocannabinoid system represent novel therapeutic approaches that may be used for the prevention of diabetes.Keywords: cardiometabolic risk, abdominal obesity, dyslipidemia, diabetes, insulin resistance, endocannabinoid system

Background: Enteric fever, a common infection in the tropics and endemic to India, often manifests as an acute febrile illness. However, presentation as fever of unknown origin (FUO) is not uncommon in tropical countries. Methods: We aim to describe the clinical, laboratory and pathological features of cases hospitalized with fever of unknown origin and diagnosed as enteric fever. All culture proven cases of enteric fever were analyzed retrospectively over a period of three years from January 2011 to December 2013. Results: Seven of 88(8%) cases with enteric fever presented as FUO. Abdominal pain was the most common symptom besides fever. Relative bradycardia and splenomegaly were uncommon. Thrombocytopenia was the most common haematological abnormality, while leucopenia was rare. Transaminase elevation was almost universal. S.Typhi and S.Paratyphi were isolated from six cases and one case respectively. Yield of organisms from blood culture was superior to that of bone marrow aspirate. Multiple granulomas were identified in 4 out of 6 (67%) of the bone marrows studied, including that due to S. Paratyphi and histiocytic hemophagocytosis was noted in two cases. Conclusion: FUO is a relatively common manifestation of enteric fever in the tropics. Clinical and laboratory features may be atypical in such cases, including absence of relative bradycardia, leucopenia and presence of thrombocytopenia, bicytopenia or pancytopenia. Moreover, in endemic countries, enteric fever should be considered as a differential diagnosis, next to tuberculosis, in the evaluation of bone marrow granulomas in cases with FUO and culture correlation should be mandatory.

Hemophagocytic lymphohistiocytosis (HLH) has a well known association with lymphomas, especially of T cell origin. Prognosis of lymphoma associated HLH is very poor, especially in T cell lymphomas; and, therefore, early diagnosis might alter the outcome. Though association of HLH with systemic anaplastic large cell lymphoma (ALCL) is known, its occurrence in primary cutaneous ALCL (C-ALCL) is distinctly rare. We aim to describe a case of C-ALCL (anaplastic lymphoma kinase (ALK)−) in an elderly male who succumbed to the complication of associated HLH, which was possibly triggered by coexistent virus infection. We briefly present the literatures on lymphoma associated HLH and discuss the histopathological differentials of cutaneous CD30+ lymphoproliferative disorders. We do suggest that HLH may pose diagnostic challenges in the evaluation of an underlying lymphoma and hence warrants proper evaluation for the underlying etiologies and/or triggering factors.

BACKGROUND: Scrub typhus is prevalent in India although definite statistics are not available. There has been only one study on scrub typhus meningitis 20 years ago. Most reports of meningitis/meningoencephalitis in scrub typhus are case reports. METHODS: A retrospective study done in Pondicherry to extract cases of scrub typhus admitted to hospital between February 2011 and January 2012. Diagnosis was by a combination of any one of the following in a patient with an acute febrile illness--a positive scrub IgM ELISA, Weil-Felix test, and an eschar. Lumbar puncture was performed in patients with headache, nuchal rigidity, altered sensorium or cranial nerve deficits. RESULTS: Sixty five cases of scrub typhus were found, and 17 (17/65) had meningitis. There were 33 males and 32 females. Thirteen had an eschar. Median cerebrospinal fluid (CSF) cell count, lymphocyte percentage, CSF protein, CSF glucose/blood glucose, CSF ADA were 54 cells/µL, 98%, 88 mg/dL, 0.622 and 3.5 U/mL respectively. Computed tomography was normal in patients with altered sensorium and cranial nerve deficits. Patients with meningitis had lesser respiratory symptoms and signs and higher urea levels. All patients had received doxycycline except one who additionally received chloramphenicol. CONCLUSION: Meningitis in scrub typhus is mild with quick and complete recovery. Clinical features and CSF findings can mimic tuberculous meningitis, except for ADA levels. In the Indian context where both scrub typhus and tuberculosis are endemic, ADA and scrub IgM may be helpful in identifying patients with scrub meningitis and in avoiding prolonged empirical antituberculous therapy in cases of lymphocytic meningitis.

We report a 49-year-old diabetic with dengue hemorrhagic fever who developed fulminant hepatitis, severe coagulopathy, shock, and refractory metabolic acidosis and died on the eighth day of illness. This is the only second report of an adult with fatal fulminant hepatic failure due to dengue, and the first case arising from a primary dengue infection.

Obesity, the most common cause of insulin resistance, is increasingly recognized as a low-grade inflammatory state. Adipocyte-derived resistin is a circulating protein implicated in insulin resistance in rodents, but the role of human resistin is uncertain because it is produced largely by macrophages.The effect of endotoxin and cytokines on resistin gene and protein expression was studied in human primary blood monocytes differentiated into macrophages and in healthy human participants. Inflammatory endotoxin induced resistin in primary human macrophages via a cascade involving the secretion of inflammatory cytokines that circulate at increased levels in individuals with obesity. Induction of resistin was attenuated by drugs with dual insulin-sensitizing and anti-inflammatory properties that converge on NF-kappaB. In human study participants, experimental endotoxemia, which produces an insulin-resistant state, causes a dramatic rise in circulating resistin levels. Moreover, in patients with type 2 diabetes, serum resistin levels are correlated with levels of soluble tumor necrosis factor alpha receptor, an inflammatory marker linked to obesity, insulin resistance, and atherosclerosis.Inflammation is a hyperresistinemic state in humans, and cytokine induction of resistin may contribute to insulin resistance in endotoxemia, obesity, and other inflammatory states.