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Diabetic peripheral neuropathy (DPN) is considered to be a risk factor for development of sarcopenia. Therefore, our study aimed to detect the association between peripheral neuropathy with skeletal muscle mass and function in type two diabetes mellitus (T2DM) patients.A total of 176 participants, ≥45 years were included in the study. Out of 176, 60 were healthy volunteers, 60 had T2DM without neuropathy, 56 had T2DM with neuropathy. In all the participants peripheral nerve function was assessed by nerve conduction studies (Common peroneal and Sural nerve) and sarcopenia parameters were evaluated according to the Asian Working Group for Sarcopenia (AWGS) criteria.The present study suggested that diabetic peripheral neuropathy (DPN) was associated with decline in muscle mass, which was found only in men. Our study showed a positive correlation between appendicular skeletal muscle index (ASMI) and common peroneal nerve amplitude and sural nerve amplitude with r=0.527, p0.05; r=0.847, p0.001 respectively. Furthermore, in multiple linear regression analyses, we found a positive relationship between ASMI and sural nerve amplitude after adjustment for confounders like age, duration of diabetes, and HbA1C (B=0.739; p0.001).As DPN patients are more prone to developing sarcopenia, and periodic assessment of skeletal muscle mass and function is warranted to initiate early lifestyle interventions in these patients, which will improve their quality of life.

Physical fitness was an important aspect for leading a complete life. Women, in general, have lesser involvement on a physical fitness regime. To maintain the youthfulness of body, regular physical activity and exercise was a key ingredient. This study aims to assess the effect of aerobic training on body composition among sedentary women of Manipur. The study made random inclusion of subjects who volunteer to participate in the training programme from Lairikyengbam Leikai, Imphal East District Manipur. Totally 30 subjects of age 46.5±4.9 years who volunteer to participate in the training were selected and minimize as control group and experimental group with N=15 each. Medical examination was conducted prior to training under registered practitioner. The training intensity was determining by using Karvonen formula. The training was given for 8 weeks regularly for 3 days alternately to determine the changes brought by training on body fat and fat free mass. The measurement was done before training as baseline score and after completion of 8 weeks as final score using Bio Electrical Impedance Analysis (BIA) method, TANITA TBF300. The paired t test was used to analyze the data at a 0.05 level of significance for pre-and post-difference comparisons, followed by an independent t test to compare the mean difference between groups using SPSS software20. It shows statistically significant decrease in body fat (P 0.05). It also shows that fat mass has a significant difference between the experimental and control groups while fat free mass shows no significant difference between groups. The result indicates that aerobic training can be an effective program for body fat reduction and positively alter one's body composition.

Presence of non-metallic inclusion deteriorates quality of steel and causes nozzle clogging during casting. Nozzle clogging eventually leads to a disruption of normal casting operations. This happens when solid alumina inclusions get accumulate in the nozzle of submerged entry nozzle (SEN). Therefore, it is required to understand the inclusion characteristics (shape, size and chemistry), which forms during the steelmaking process. Calcium is added in the steel ladle furnace (LF) in the form of CaSi wire to modify inclusions and to desulphurize steel. The range in which all the oxides become liquid and no solid sulphides begin to form is regarded as the "optimum window" or “liquid inclusion window” for calcium treatment. It is a target to obtain this calcium addition window, during calcium addition in the ladle furnace. This window mainly depends on the sulfur and total oxygen contents of the liquid steel bath. In the present study, inclusions characteristics such as volume fraction of inclusions, inclusion rating and EDS analysis of inclusions has been carried out using SEM-EDS. Thermodynamic study is carried out using thermodynamic software FACTSAGE and databases to find out formation of various calcium aluminates and the precipitation of CaS. Results show that liquid inclusion window mainly depends mainly on the sulphur level, total oxygen and aluminum content in the steel. These windows will help in calculation of calcium addition range for optimizing the addition of calcium in the ladle. These nomograms have been validated with actual plant condition to reduce the nozzle clogging during continuous casting.

In India, diabetic nephropathy (DN) is the most common cause of chronic kidney disease. Timely detection of microalbuminuria and appropriate intervention can reverse or arrest the progress of nephropathy. The pathogenesis of diabetic nephropathy has revealed that during the early onset of kidney involvement in diabetics, inflammation and fibrosis progress from tubular to glomerular damage. This study was designed to elucidate the association of chemokines, Omentin 1, and interleukin 6 (IL-6) with microalbuminuria.Settings and Design: This cross-sectional observational study was conducted as a collaborated study in the Departments of General Medicine and Biochemistry, All India Institute of Medical Sciences, Bhubaneswar, India, during 2019-2020.Our study group comprised 116 diabetes mellitus patients. They were grouped into two, each of 58 on the basis of their urine albumin levels; Group 1 (controls) had UACRlt; 30 μg/mg, eGFRgt; 90ml/ min and Group 2 (cases) had UACR ≥ 30 μg/mg andlt; 300 μg/mg, eGFRgt;60ml/min andlt; 90ml/min. Serum omentin 1 and IL-6, creatinine, glycated haemoglobin (HbA1c), fasting (FBS) and postprandial blood sugar (PPBS), lipid profile, total protein, albumin, and fasting insulin, HOMA-IR were studied.Our study showed that Omentin 1 levels were decreased, and IL-6 levels were increased in the DN group compared to the T2DM without DN. The risk estimates calculated revealed that diabetes mellitus patients having an IL-6: omentin ratio ≥ 0.26 had Odds of 3.97 of developing DN, which was statistically significant (CI 2.36-6.68). Therefore, a ratio of ≤ 0.26 was found to be kidney protective among diabetes mellitus patients.From the results of this present study, we recommend that estimation of serum IL-6: omentin 1 ratio of T2DM will aid in identifying early stages of DN before the onset of microalbuminuria.

A 70-year-old male presented with complaints of fever for 10 days; associated with dry cough for one week, gradually progressive shortness of breath for five days, and non-radiating chest pain for three days. Chest examination revealed bilateral basal crepitation, and cardiac examination showed muffled first heart sound with soft systolic murmur at apex. All severity markers of COVID-19 were elevated. Twelve lead electrocardiography (ECG) showed complete heart block. Troponin-I test was negative. High resolution computed tomography (HRCT) thorax showed extensive bilateral multifocal patchy and confluent areas of ground-glass opacities distributed along with peripheral subpleural and peribronchovascular regions with interlobular septal thickening suggestive of viral pneumonia .He was started on high flow oxygen, parenteral corticosteroids, and anticoagulants with antibiotics coverage. Injection Isoprenaline infusion was started for heart block, but the patient developed atrial flutter-fibrillation with premature ventricular complexes. The patient clinically improved and was discharged on the 11th day of admission. On follow up after 2 weeks, repeat ECG showed atrial fibrillation, and 2D Echocardiography revealed global hypokinesia, severe mitral regurgitation with left ventricular systolic dysfunction (ejection fraction of 28%), and dilated left ventricle and atrium. He was planned for coronary angiography after one month. High clinical suspicion, early diagnosis, and prompt treatment with corticosteroids can yield a favorable outcome. Follow up is necessary to rule out long term complications like viral cardiomyopathy.

Myelin oligodendrocyte glycoprotein antibody disease (MOGAD) is a recent addition to the field of central nervous system inflammatory disorders. It can have a wide range of presentations, including optic neuritis, transverse myelitis, acute disseminated encephalomyelitis or any combination of these. The aquaporin-4-positive neuromyelitis optica (NMO) is a close differential owing to the similar clinical presentation. There is a proven association between NMO and autoimmunity, whereas such an association is yet to be established in the case of MOGAD. Here we describe the case of a woman in her 30s presenting with sudden-onset quadriparesis with sensory and autonomic involvement who was diagnosed with MOGAD (cervicothoracic longitudinally extensive transverse myelitis) and found to have primary Sjogren syndrome on further workup. This association between MOGAD and autoimmunity should be kept in mind, as diagnosis of the former should alert the physician to the possibility of the latter’s existence and the need to initiate an appropriate workup.

Background:One of the commonest complications of poorly controlled Type 2 diabetes mellitus (T2DM) is Diabetic nephropathy (DN), which occurs in 30-40% of DM cases. It is important to identify the high-risk group who are likely to develop DN with the modifiable and non-modifiable risk factors. This study had the objectives to estimate and correlate the levels of the urine albumin creatinine ratio (UACR) with age, anthropometric measures, glycaemic control markers, lipids, and renal function. To estimate each variable as independent and multivariate risk factors. Materials and Methods:It was an observational and cross-sectional study conducted in a tertiary care center in Eastern India. Totally, 221 consecutive ambulatory T2DM subjects were recruited after obtaining their written consent. Results:The diabetics were classified as having diabetic nephropathy by the urine albumin creatinine ratio (ACR) of >30 mg/gm. 53.4% of our study group had DN. There was a significant risk associated with PPBS with p=0.043 ( Conclusion:The additive factors contributed by the risk factors in the prediction of DN will benefit the DM in the prevention of DN. Keywords:diabetic nephropathy, risk factors, diabetic kidney disease, Asian Indian

We present a rare case of Brucella endocarditis in a case of the bicuspid aortic valve in a 51-year-old male presenting with pyrexia of unknown origin for the last 2 months. Infective endocarditis caused by Brucella melitensis is rare to encounter in routine clinical practice. Although we routinely think of Mycoplasma, Legionella, and Coxiella in the cases of blood culture-negative endocarditis, one should think of Brucella melitensis and Scrub typhus as the last arrow to reach the final etiology of infective endocarditis in the subset of diseased aortic or mitral valve. We successfully treated the patient with a combined regimen of rifampicin, gentamicin, and doxycycline therapy; during follow-up, the vegetation of the aortic valve was shrunken and calcified and the patient was asymptomatic.

Abstract: Sarcopenia is a disease characterized by a gradual decline in skeletal muscle mass and strength that accompanies the normal aging process. The disease is associated with various adverse health outcomes in the geriatric population, such as prolonged hospital admission, disability, poor quality of life, frailty, and mortality. Factors involved in the development of age-related sarcopenia include anorexia, hormone level alterations, decreased neural innervation, low muscular blood flow, cytokine dysregulation, altered mitochondrial activity, genomic instability, intracellular proteolysis, and insulin resistance. Understanding the underlying mechanisms may facilitate the development of efficient prophylactic and therapeutic strategies to improve the quality of life in elderly individuals. Thus, the present review highlights literature regarding the mechanism of sarcopenia development in elderly patients.

A 53-year-old man with diabetes came to the emergency department with fever and dry cough for 5 days, swelling of the left leg for 2 days, shortness of breath and chest pain for 1 hour. He had raised temperature, tachycardia, tachypnoea, reduced oxygen saturation and swollen tender left leg on examination. The frontal chest radiograph showed bilateral ground-glass opacities; he tested positive for COVID-19 with elevated D-dimer. The colour Doppler examination of the left leg revealed acute deep vein thrombosis (DVT) of the common femoral and the popliteal veins. The chest CT showed bilateral diffuse ground-glass opacities predominantly involving peripheral zones and the lower lobes. The CTPA revealed left pulmonary thromboembolism (PTE), treated with low-molecular-weight heparin. COVID-19 predominantly affects the respiratory system. DVT and PTE are common in COVID-19 but lethal. They should be diagnosed early by clinical and radiological examinations and treated promptly with anticoagulants.

Paraquat (1,1’-dimethyl-4,4’-dipyridylium) is a liquid herbicide associated with accidental and suicidal ingestion, leading to fatal toxicity. It can lead to multiple organ dysfunction, including metabolic acidosis, acute kidney and liver injury, pulmonary fibrosis, and acute respiratory distress syndrome (ARDS). Very rarely, this can present with spontaneous pneumothorax or pneumomediastinum or both, which are poor prognostic markers with a mortality rate of almost 100%. Here, we present a young male presenting with paraquat poisoning followed by the development of both pneumothorax and pneumomediastinum and death from respiratory failure. Paraquat poisoning should always be considered in the differential diagnosis in patients presenting with spontaneous pneumothorax or pneumomediastinum in places with high paraquat poisoning prevalence.

Eosinophilic ascites is a manifestation of serosal eosinophilic gastrointestinal disease. We present a 44-year-old male with low serum ascites albumin gradient with high eosinophil count and contrast-enhanced computed tomography of the abdomen showing circumferential wall thickening of the esophagus, mid to distal ileal loops, and ascending colon. The patient was managed with tablet prednisolone 20 mg twice daily for two weeks, then gradual tapering over one month. The patient responded to treatment. Awareness of the condition, timely diagnosis, and early treatment carries excellent responses.

Poisoning is one of the more conventional modes of suicide in some parts of India. Aluminium phosphide (ALP) is a chemical used for this purpose and manifests severe cardiovascular complications, such as hypotension, shock, various arrhythmias, congestive heart failure with toxic myocarditis, and in rare cases, ST-segment elevation myocardial infarction or other electrocardiogram changes. Upon contact with moisture, ALP yields phosphine gas, a toxic systemic poison found in pesticides that can lead to cardiovascular-related mortality. We present a case of ALP poisoning in a 60-year-old woman who was asymptomatic for the first 48 hours. She gradually developed cardiac complications in the form of anteroseptal acute myocardial infarction (AMI). As AMI is very rare among the various cardiac complications, an early vigilance is necessary to prevent further complications in ALP poisoning.

Temperature-driven, highly sensitive and selective “TURN-ON” fluorometric detection of Zn2+ by benzothiazole-based probes (L1 and L2) was reported in physiological pH in the present work. Iron(II) acted as the reversible switch or trigger for the reversible detection of Zn2+ ions by the probes resulting in “TURN-OFF” fluorescence at room temperature. However, selective detection of Zn2+ in the presence of Fe2+ was irreversible at 0–5 °C. Such temperature dependence on reversible fluorometric detection of Zn2+ in the presence of Fe2+ was explained from the thermodynamic perspective as well as DFT calculations in which the absolute enthalpy (H) and Gibbs free energy (G) of the resultant complexes and the fluorophores (L1 and L2) at different temperatures were determined. Enhanced fluorescence of the Zn2+ bound probes was due to the inhibition of excited-state intramolecular proton transfer (ESIPT). Effect of solvents, pH, and temperature on the fluorometric detection of Zn2+ was also probed in the present work. The results were translated into the visual detection of Zn2+ on paper-based fluorescence probe and later we demonstrated the sensing of mobile Zn2+ ions by the probes in living HeLa cells as the proof of concept of our present investigations. A benzothiazole-based, “TURN-ON” fluorescent sensor was developed for selective and reversible detection of Zn2+in vitro, in which Fe2+ acted as the reversible switch.

Isolated tubercular liver abscess (TLA) without the involvement of other organs is an extremely rare presentation of tuberculosis. This report describes a 23-year-old man who presented with a three-month history of fever and weight loss. Ultrasonography (USG) and contrast-enhanced computed tomography (CT) of the abdomen showed two abscesses in the liver, measuring 44 x 37 mm and 27 x 22 mm. Ultrasound-guided fine-needle aspiration was performed, with cytology confirming that the abscesses were tubercular. The patient was advised to start anti-tubercular therapy for six months. Although rare, TLAs should be considered in the differential diagnosis of fine-needle aspiration of patients with liver abscesses and prolonged fever. Early diagnosis and timely intervention will prevent morbidity and mortality in such patients.

Multicentric reticulohistiocytosis (MRH) is a rare multisystem macrophage disorder of unknown etiology characterized by papulonodular skin and mucosal lesions, rapidly progressive erosive symmetric polyarthritis, and inflammation of internal organs. Most often, it is misdiagnosed as rheumatoid arthritis (RA). Here, we report the case of a 60-year-old woman found to have features of both MRH and RA with positive rheumatoid factor and high titer of anti-cyclic citrullinated peptide antibody in serum. It was confirmed by a histopathology of skin lesions, which showed diffuse histiocytic infiltrate with multinucleated giant cells. She was treated with methotrexate, hydroxychloroquine, corticosteroids, and nonsteroidal anti-inflammatory drugs and bisphosphonate.

Introduction: Acute poisoning is an important cause of morbidity and mortality in India. It is estimated that more than 50,000 people die every year from toxin exposure. In India, intentional cases alone reach some 126,000 cases annually and organophosphorus compounds constitute major poisonings. Materials and Methods: A cross sectional, descriptive study was conducted among 30 cases of acute poisoning admitted in Prathima Institute of Medical Sciences, Karimnagar, Andhra Pradesh during September 2011-12. Socio-demographic variables assessed were age, sex and area wise distribution of the respondents. Type of poison, the amount ingested, clinical presentation and outcome were studied. Results: In this study, maximum cases 13 (43.4%) were between 17 to 20 years, males 17 (57%) were more commonly involved in acute poisoning and 20 (67%) cases came from rural areas. The majority 13 (43.3%) of cases were organophosphates poisonings and 28 (93%) of cases were of suicidal intentions. Most of the suicidal poisonings were due to economical problems 14 (50%), followed by broken relationships 6 (21%) and studies related reasons were observed in 5 (18%) of cases. Out of total 30 cases of poisonings in this study, 26 cases (86.66%) were recovered completely, whereas 4 cases (13.3%) expired. Conclusion: Prevention of poisoning requires further exploration of underlying factors in their cultural context and effective strategies including management of these problems. Changing the knowledge, attitudes and behaviors of the community and improvement in the medical treatment plan is required to curtail the incidence and mortality

Zinc Sulphide (ZnS) nanoparticles doped with different concentrations of Mn 2+ (0%, 2%, 4%, 6%, 8%, 10%) have been synthesized by chemical co-precipitation method using polyvinyl alcohol (PVA) as a capping agent to control the particle growth. The structural characterizations of as synthesized nanoparticles are determined by X-ray diffraction (XRD) which showed cubic zinc blende structures with average crystallite sizes of the range 2.3 nm - 2.1 nm. There is no phase transformation due to Mn 2+ doping and this characteristic has been observed in all the synthesized powder. Scanning electron microscopy (SEM) and energy dispersive X- ray (EDX) analysis show the morphology and elemental analysis of as synthesized nanoparticles.TEM images confirms the spherical shape of the nanoparticles. HRTEM and SAED images show the crystalline nature and confirm the cubic nature of ZnS nanoparticles. Absorption study has been carried out by using UV-Vis spectrophotometer to determine the band gap of ZnS:Mn nanoparticles and they showed a blue shift with respect to the bulk. The effect of Mn 2+ substitution on the photoluminescence properties of doped samples is also studied and doped ZnS:Mn showed enhanced luminescence property compared with that of the undoped ZnS nanoparticles. Radius of the synthesized nanoparticles has been evaluated from the absorption spectrum by using the Effective Mass Approximation (EMA) formula. Fourier Transform Infrared Spectra (FTIR) is recorded in an FTIR spectrometer to verify the presence and effect of capping agent.

Nanocrystalline CdS thin films were deposited on glass substrate by chemical bath deposition method using Cadmium Sulphate and Thiourea as Cd+2and S-2ion sources for different molarities i.e. 0.1 M, 0.2 M and 0.3 M. The crystallite size and lattice parameters for each sample were determined from X-Ray diffraction data using Scherrers formula. The value of the crystallite size was found to be within the range 14.7 nm-11.4 nm. The optical characterization was done by UV-Visible and photoluminescence spectroscopy. The optical band gap of the films was determined from the transmittance spectra. It was observed that when the molarity increases, the average crystallite size decreases and the band gap energy of the prepared films increases. Photoluminescence studies showed a prominent peak at around 530 nm. The radius of the nanocrystalline films had been evaluated from the absorption spectrum by using effective mass approximation formula.

Mathematical and physical simulation of fluid flow had been carried out for a scaled down model of a gas stirred 300 T ladle of Bokaro Steel Plant, Steel Authority of India Ltd. The existing ladle is equipped with two porous plugs located in adjacent quadrant at the bottom of ladle. Comparison of fluid flow and mixing efficiency of the existing arrangement is made with a modified arrangement of porous plugs located diagonally across to each other. Simulation study reveal that the modified arrangement of porous plug leads to improved mixing efficiency in the ladle. Based on the results from the simulations, the operating parameters like argon pressure and flow rate were modified. Plant trials with optimized ladle furnace (LF) operating parameters were carried out in a modified ladle having porous plugs located diagonally across. While the desulphurization efficiency improved, aluminium loss from the melt was reduced by 8.2%. Redistribution of the gas plumes from adjacent quadrant to diagonal quadrant led t...