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Background This study aimed to determine the relationships between hematological parameters- hemoglobin, Total Leucocyte Counts (TLC), platelet counts, Absolute Neutrophil Counts (ANC), Absolute Lymphocyte Counts (ALC), Neutrophil Lymphocyte Ratio (NLR), Systemic Immune Inflammatory Index (SII), Neutrophil Monocyte Ratio (NMR), Platelet Lymphocyte Ratio (PLR) and the severity of COVID-19 disease and their use in predicting severity of COVID-19 disease. Methods and Material This was a prospective, observational, single-center study of 573 symptomatic adult inpatients of COVID 19 admitted to our tertiary care center. Statistical analysis used The above-mentioned hematological parameter levels were noted and compared between the two categories of COVID-19 disease, namely non-severe and severe COVID-19 using logistic regression methods. Their cut-off values were detected using the ROC curve. Results The median TLC, ANC, NLR, SII, NMR, PLR were notably higher in patients with severe COVID-19 than in those with non-severe COVID-19. Logistic regression analysis showed that NMR (OR=1.029, p=0.006) and ALC (OR=0.999, p=0.002) were statistically significant independent predictors of COVID-19 severity. Conclusions The hematological parameters mentioned, can be used for predicting severe COVID-19 disease at admission. ALC and NMR levels could be used as hematological markers to predict severity of COVID-19 in adult patients with their cut off values being < 1105 cells/cubic millimeter and > 10.434 respectively.

Background: Dipeptidyl peptidase-4 (DPP-4) inhibitors are oral hypoglycemic agents widely prescribed in India despite safety concerns. However, studies focused on their safety profile are scarce, especially in South India. Objective: To evaluate the prevalence and predictors of adverse events (AEs) with DPP-4 inhibitors in patients with type 2 diabetes mellitus (T2DM). Research design and methods: This retrospective cross-sectional study analyzed data from medical records of T2DM patients prescribed DPP-4 inhibitors admitted to the medicine department from 2019 to 2021 at a South Indian tertiary care hospital. The causality of AEs was assessed using the WHO-Uppsala Monitoring Centre (WHO-UMC) criteria and the Naranjo scale, and severity using the Modified Hartwig and Seigel scale. We applied a Generalized model with a binary response and logit-link function to understand the factors that best explain the AE. The best-fit models were chosen based on least Akaike’s information criterion and highest Pseudo R 2 and presented the odds ratio (OR) with a 95% confidence interval. The analyses were performed in R software version 4.2.1. Results: Among the 796 patients included in the study, 26% experienced AEs. A total of 212 AEs were observed, and Saxagliptin-associated AEs were the most prevalent (66.6%). Hepatic AEs were predominant (37.7%), followed by gastrointestinal events (16.5%) and electrolyte imbalances (12.3%). Most AEs were possible based on WHO-UMC criteria (78.7%) and the Naranjo scale (86.7%), with 58% being of moderate severity and 42% mild. In the multivariate analysis, aspartate transaminase [OR: 1.013 (0.006–1.020)], alkaline phosphatase [OR: 1.004 (1.001–1.007)] and patients already on DPP-4 inhibitors [OR 1.191(1.012–1.366)] were significant predictors for AEs with DPP-4 inhibitors. Conclusion: The study highlighted a high prevalence of AEs with DPP-4 inhibitors and identified significant predictors of these AEs. These findings underscore the necessity of vigilant monitoring and risk assessment while prescribing DPP-4 inhibitors to the Indian population.

Background This study aimed to determine the relationships between hematological parameters- hemoglobin, Total Leucocyte Counts (TLC), platelet counts, Absolute Neutrophil Counts (ANC), Absolute Lymphocyte Counts (ALC), Neutrophil Lymphocyte Ratio (NLR), Systemic Immune Inflammatory Index (SII), Neutrophil Monocyte Ratio (NMR), Platelet Lymphocyte Ratio (PLR) and the severity of COVID 19 infections and their use in predicting severity of COVID-19 infections. Methods and Material This was a prospective, observational, single-center study of 573 symptomatic adult inpatients of COVID 19 admitted to our tertiary care center. Statistical analysis used The above-mentioned hematological parameter levels were noted and compared between the two categories of COVID-19 infection, namely non-severe and severe COVID-19 using logistic regression methods. Their cut-off values were detected using the ROC curve. Results The median TLC, ANC, NLR, SII, NMR, PLR were notably higher in patients with severe COVID-19 than in those with non-severe COVID-19. Logistic regression analysis showed that NMR (OR=1.029, p=0.006) and ALC (OR=0.999, p=0.002) were statistically significant independent predictors of COVID-19 severity Conclusions The hematological parameters mentioned, can be used for predicting severe COVID-19 infections at admission. ALC and NMR levels could be used as hematological markers to predict severity of COVID-19 in adult patients with their cut off values being < 1105 cells/cubic millimeter and > 10.434 respectively.

Introduction Patients with chronic kidney disease (CKD) are at increased risk of developing tuberculosis (TB). These patients may also be at higher risk of developing antitubercular treatment (ATT)-associated adverse drug reactions (ADRs). Although dose modification has been recommended, data regarding the impact of impaired kidney function on ATT-associated ADRs is sparse. We studied the incidence and profile of ATT-associated ADRs in patients with CKD and compared them with those with normal kidney function.Methodology This retrospective study analyzed all patients initiated on ATT from January 2016 to August 2019. Patients were grouped into CKD and normal kidney function based on their eGFR. Data on ATT-associated ADRs were collected from medical records. Predictors of ADRs were assessed using univariable and multivariable logistic regression. Additionally, Propensity score matching and analysis were done for CKD and normal kidney function in 1:3 ratio.Results Of 1815 patients on ATT, 75 (4.1%) had CKD. ADRs were more frequent [36/75 (48.0%) vs. 239/1740 (13.7%), p ≤ 0.0001] and more severe [15/46 (32.6%) vs. 43/283 (15.1%), p = 0.010] in CKD than those with normal kidney function. The most common ADRs were hepatobiliary [23/75 (30.6%) vs. 156/1740 (8.9%), p ≤ 0.0001], neuropsychiatric [8/75(10.6%) vs. 21/1740(1.2%), p ≤ 0.0001], renal [4/75(5.3%) vs. 8/1740(0.4%), p = 0.001], and gastrointestinal [5/75(6.6%) vs. 34/1740 (1.9%), p = 0.020]. CKD was an independent predictor for ADRs (OR −4.96, 95% CI: 2.79–8.82; p ≤ 0.0001). The matched cohort showed similar results.Conclusion ATT-associated ADRs were more common and severe in patients with CKD, despite drug dose modifications. Optimal dosing of ATT in CKD needs to be further evaluated.

الملخص: أهداف البحث: يسبب اعتلال الكلية السكري مضاعفات في القلب والأوعية الدموية لدى الأفراد المصابين بداء السكري، مما يؤدي إلى انخفاض وظائف الكلى والتدهور الجسدي العام. كان الهدف من هذه المراجعة المنهجية هو تحديد تأثير التمرين على متغيرات وظائف الكلى المختلفة بين الأفراد المصابين بداء السكري من النوع الثاني واعتلال الكلية. طرق البحث: تم تسجيل المراجعة المنهجية في قاعدة بيانات ''بروسبيرو''، وتم البحث في قواعد البيانات التالية: ميدلاين، وسكوبس، وشبكة العلوم، وسيناهل، وبروكويست، وكوكران. من بين 1734 سجل وجدت فقط أربع تجارب معشاة ذات شواهد، وتم تضمينها في التوليف النوعي والكمي بعد فحص أهلية الدراسة في مرحلة العنوان والملخص والنص الكامل. النتائج: تضمنت المراجعة ما مجموعه 203 شخصا (103 في مجموعة التدخل و 100 في المجموعة الضابطة / القياسية) مصابين باعتلال الكلية السكري من النوع 2 أو مرض الكلى المزمن في المراحل 2 و 3 و 4. استخدمت ثلاث من الدراسات الأربع مبدأ ''فيت'' (التكرار، والشدة، والوقت، والنوع) في تدريب التمرينات والوصفات الطبية. تلقت مجموعة التدخل تمارين هوائية ومقاومة، منزلية، خاضعة للإشراف، ومنظمة. أظهر التحليل التلوي عدم وجود تأثير للتمرين على كرياتينين المصل، وسيستاتين المصل، ومعادلة الكرياتينين، ومعادلة سيستاتين، ومعادلة الكرياتينين-سيستاتين. ومع ذلك ، فقد أدت التمارين الرياضية إلى خفض نسبة الألبومين البولي إلى نسبة الكرياتينين، ونسبة البروتين البولي إلى نسبة الكرياتينين، ونتروجين اليوريا في الدم، وإزالة الكرياتينين، وإفراز البروتين في البول مع زيادة تصفية اليوريا. الاستنتاجات: هناك دليل محدودة على دور التمارين في وقاية الكلى وتغيير معايير وظائف الكلى بين مرضى السكري من النوع الثاني المصابين باعتلال الكلية. Abstract: Diabetic nephropathy causes cardiovascular complications among individuals with diabetes which results in decreased kidney function and overall physical decline. The objective of this systematic review was to determine effects of exercise on various renal function parameters amond individuals with type 2 diabetes and nephropathy. It was registered with PROSPERO (CRD42020198754). Total 6 databases (PubMed/Medline, Scopus, Web of Science, CINAHL, ProQuest, and Cochrane) were searched. Among 1734 records, only four randomized controlled trials were included. The review included a total of 203 participants (103 in the intervention group and 100 in the control/standard group) with type 2 diabetic nephropathy or stage 2,3, or 4 of chronic kidney disease. The meta-analysis showed no effects of exercise on serum creatinine, serum cystatin c and varied eGFR equations. However, exercise decreased urinary albumin to creatinine ratio, urinary protein to creatinine ratio, serum urea nitrogen, creatinine clearance, and urinary protein excretion while increasing urea clearance. Limited evidence on the reno-protective role of exercise demands future research in this direction.

Background: Ferritin, an intracellular protein, has a pivotal role in immune dysregulation. Hyperferritinemia has been associated with higher disease severity and adverse clinical outcomes in COVID-19, including mortality. We aimed to study the association of serum ferritin levels with disease severity and clinical outcomes and its severity prediction potential in COVID-19 patients. Methods: This retrospective study included 870 adult patients with symptomatic COVID-19 infection hospitalized between July 1, 2020 to December 21, 2020. All the patients had a positive polymerase chain reaction test result of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results: The median age was 55 (IQR:40, 65) years with a male predominance [66.32% (n = 577)], among 870 COVID-19. Of these, 413 (47.47%) had mild COVID-19, and 457 (52.53%) had moderate plus severe COVID-19 disease. Median ferritin levels were significantly high in moderate to severe COVID-19 infection compared to mild [545.8 (326.0, 1046.0) vs 97.3 (52.65–155.5) (p = 0.001)], and in patients who developed a complication compared to without complications [380 (177.05, 863.15) vs 290 (110.9, 635) (p = 0.002). A slight elevation in median ferritin levels was observed in patients who had an ICU stay than non-ICU [326 (129.8, 655) vs 309 (119.1, 684) (p = 0.872)]. The cut-off for ferritin was identified at >287.4 ng/ml for mild versus moderate plus severe COVID-19 infections. Conclusion: Moderate to severe COVID-19 patients have elevated ferritin levels. Patients with more than 287.4 ng/ml ferritin value would have greater chances of developing moderate to severe COVID-19 infections.

Background: Cerebrovascular accidents (CVAs) are the leading cause of morbidity and mortality. Several comorbidities have been associated with increased mortality in acute stroke patients. Conditions such as hypertension, dyslipidemia, diabetes mellitus, and thyroid dysfunction are identified as risk factors in the etiology of stroke. Methods: This is a prospective study involving 40 patients admitted with acute stroke between October 2010 and July 2012 in Kasturba Hospital, Manipal, under the Departments of Medicine and Neurology. Results: Thyroid dysfunction has been associated with CVAs and is an area of active research in the present times. Conclusion: Low T3 level was associated with unfavorable outcome and with posterior circulation stroke as accessed using the National Institutes of Health Stroke Scale.

The photonic post-processing of suspended carbon nanotube (CNT) ribbons made by floating catalyst chemical vapor deposition (FC-CVD) results in selective sorting of the carbon nanotubes present. Defective, thermally non-conductive or unconnected CNTs are burned away, in some cases leaving behind a highly crystalline (as indicated by the Raman G:D ratio), highly conductive network. However, the improvement in crystallinity does not always occur but is dependent on sample composition. Here, we report on fundamental features, which are observed for all samples. Pulse irradiation (not only by laser but also white light camera flashes, as well as thermal processes such as Joule heating) lead to (1) the sweating-out of catalyst nanoparticles resulting in molten catalyst beads of up to several hundreds of nanometres in diameter on the textile surface and (2) a significant improvement in CNT bundle alignment. The behavior of the catalyst beads is material dependent. Here, we show the underlying mechanisms of the photonic post-treatment by modelling the macro- and microstructural changes of the CNT network and show that it is mainly the amount of residual catalyst which determines how much energy these materials can withstand before their complete decomposition.

Organophosphate (OP) and mixed pesticide poisoning remains an important cause of hospital admission. Therefore, physician must be aware of atypical presentations of delayed neurological complications of poisoning by taking proper patient history. We report a case of a 23-year-old female who presented with high stepping gait and muscle wasting in hands. Patient history revealed consumption of approximately 4ml of mixed pesticide, consisting of 50% chlorpyrifos with synthetic pyrethroid, 5% cypermethrin. The prolonged and severe nature of delayed peripheral neuropathy, persisting at two years of follow-up, suggests that even small quantities of OP taken in combination with a pyrethroid can result in significant morbidity and is irreversible.

Multidrug-Resistant tuberculosis (MDR TB) is major health hazard to the people living in developing countries. As incidence rate of MDR TB has gone up, its therapy has become crucial. MDR TB therapy is known to cause multiple adverse effects however the data related to them is minimal. Hypothyroidism is one of the important adverse effects which usually manifests with vague symptoms and is frequently missed. We present a case of 24-year-old woman who was diagnosed to have MDR TB and started on ethionamide based regimen for same. After 6 months of therapy the patient had clinical symptoms suggestive of hypothyroidism, laboratory investigations confirmed it. As ethionamide is an integral component of MDR TB therapy it was continued and thyroxine replacement therapy was given with which she improved. Hypothyroidism completely resolved after 2 months of stoppage of MDR TB therapy suggesting the reversible aetiology of ethionamide.

Objective: To document the various clinical manifestations, lab parameters, complications and outcomes of Falciparum Malaria. The above data would be correlated with the parasitic index to deduce whether it would be an effective measure of the same. Methods: This was a prospective study among 183 inpatients aged above 18 from Kasturba Hospital, Manipal from May 2009 to January 2011. Ethical clearance was taken. Statistical analysis was done with the independent paired t test, linear correlation and Chi square test using SPSS 16. Results: In this study 78% cases were males. Most cases occurred during the monsoons. Fever was the major presentation with others being jaundice, vomiting and head ache. 50.8 % had complications, including hepatic dysfunction (40.9%), renal failure (19.13%), shock (7%), altered sensorium (9%), ARDS (3.27%) and severe anemia (1.63%). Hypoglycemia and gram negative sepsis were rare. Parasitic index, renal parameters and death were correlating positively. ESR was significantly related (P

Graphene sheets that are now routinely obtained by the exfoliation/reduction of graphite oxide exhibit Raman spectra unlike traditional graphene systems. The general attributes of the Raman spectra of these ‘wrinkled graphene’ are first reaffirmed by evaluating the spectra of samples prepared by seven different exfoliation-reduction methods. These graphene sheets exhibit highly broadened D and G Raman bands and in addition, have a modulated bump in place of the conventional 2D (G′) band. It is shown that the high wavenumber ‘bump’ can be resolved into the conventional 2D band and several defect activated peaks such as G*, D+D′ and 2D′. The broad G band could also be deconvoluted into the actual G band and the D′ band, thereby attributing the broadening in the G band to the presence of this defect activated band. Two additional modes, named as D* at 1190 cm-1 and D** at ∼1500 cm-1 could be identified. These peculiar features in the Raman spectrum of ‘graphene’ are attributed to the highly disordered and wrinkled (defective) morphology of the sheets. The affect of defects are further augmented due to the finite crystallite size of these graphene sheets. The dispersion in the band positions and peak intensities with respect to the laser energy are also demonstrated.