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Epithelioid hemangioendothelioma (EHE) is a rare, often multifocal, intermediate-grade vascular sarcoma arising from the endothelial cells. Their behavior is intermediate between hemangioma and conventional angiosarcoma. Their rarity and unpredictable clinical behavior result in our still limited understanding and treatment options for this variety of tumors. Molecular diagnostic tools like the presence of WWTR1-CAMTA1 fusion have been developed to aid this challenging diagnosis. There is no definitive consensus on the management of patients with this disease and no commonly accepted treatment strategies have been found to be effective, particularly in the metastatic setting. When possible, surgery with clear margins should be considered in case of localized disease. Here, we not only present such a rare case of EHE of the urinary bladder but also provide a comprehensive discussion on the present treatment modalities offered, as found through a thorough search of the published studies. Finally, more studies are required to establish a standard of care for this rare entity.

IntroductionThe search for a protective antibody titer level to prevent coronavirus disease 2019 (COVID-19) infection, progression, and death is far from over. To date, no specific cut-off values have been established for these protective antibodies or neutralizing antibody (NAb) titers. NAb titers inhibit viral replication.AimTo find out the prevailing NAb titre which might give protection from COVID-19 infection, or complication arising out of it.Material and methodsThe data of COVID-19 patients with NAb titers who underwent reverse transcription polymerase chain reaction and presented with mild symptoms within 3 days after receiving the results were analyzed. The data were obtained from the clinic’s electronic database. Of the recruited patients, 63 were included in the final analysis. All statistical analyses were performed using SPSS v. 21.Results and discussionA highly significant correlation (negative) existed between circulating NAb titer and duration of fever (P < 0.001); a positive significant correlation existed between the period from the 1st vaccine dose to the period of infection and the NAb titer level (P < 0.001). The NAb titer was significantly higher in the group that received both doses (P = 0.00016). Death and admission due to progression to moderate COVID-19 occurred in the group with a NAb titer of less than 10 U/L.ConclusionsThe risk of complications and death due to COVID-19 may increase if the protective antibody level remains less than 10 U/L. The sample size used in this study was relatively small; therefore, this finding cannot be generalized. Hence, more robust studies should be performed to determine the appropriate protective NAb titer levels.

Introduction: Sleep-related problems like sleep apnea are increasing tremendously mostly owing to the disordered lifestyle the present generation is leading which is added like a topping on the base of obesity and metabolic syndrome. The burden on the society is huge taking into consideration the work-time loss and health-related financial issues arising out of these sleep disorders with obstructive sleep apnea (OSA) leading the way. Early diagnosis can prevent several complications of OSA. Cardiovascular diseases, including various arrhythmias, arising due to OSA, are described previously. Case Presentation: Herein, an interesting case of OSA, whose pacemaker installation to rectify the long pause could be avoided by simple correction of his OSA using continuous positive airway pressure, is presented. This 49-year-old male patient was diagnosed with severe OSA by using polysomnography and all his significant sinus pauses (highest one with 7.8 sec) during holter ECG monitoring were found to be occurring at night and correcting his OSA with continuous positive airway pressure (CPAP) treatment reverted all those sinus pauses and the need for any further intervention with pacemaker was discarded. Discussion: OSA is caused by either partial or complete obstruction of the upper airway, and there is the simultaneously attenuated upper airway dilator muscle tone while the patient is sleeping. The gold standard test designed for the assessment of OSA is polysomnography, as approved by the American Academy of Sleep Medicine and CPAP has been found to be universally beneficial in treating OSA related complications. Physiologically, the ACC/AHA guidelines recommend pacing only in patients with prolonged asymptomatic pauses occurring during wakefulness. This case report proved the above mentioned claim of CPAP treatment.

Introduction. The occurrence of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged as a global pandemic with huge death tolls. Coronavirus disease 2019 (COVID-19) may progress from minimal infection to serious respiratory failure mandating treatment for a continuum of developed disease condition. Aim. The purpose of this review is to summarize the findings related to epidemiology, clinical manifestations, modes of transmission, diagnosis and the treatment modalities (both experimental and repurposed) for COVID-19. Material and methods. Literature were searched using various search engines like PubMed, SCOPUS, EMBASE, J-Gate, Google Scholar to look for review articles, randomized controlled trial results, prospective studies and, retrospective studies done on COVID-19 for the purpose of this comprehensive review. Analysis of the literature. The transmission seems to be occurring through droplet, fomite and aerosols (rarely). Currently there is no specific/targeted vaccine available. Priority is highly placed to identify possible treatment approaches to circumvention this disease. Conclusion. Till we find a vaccine, we have to strategize to optimally use the existing evidence of the indirect effects of these various available drugs for therapy and maintain a strict protocol for prevention and we must use triage system to admit only those critically ill or having severe disease.

Retroperitoneal tumors can cause ureteric obstruction leading to obstructive uropathy. Early preoperative ureteric stenting helps to improve renal function and also helps in identifying ureters and prevent ureteric injury during surgery. This study was aimed at assessing the outcome of preoperative stenting in optimizing such patients. A total of 24 cases were enrolled. Of these, 15 patients who had obstructive uropathy were taken for ureteric stenting preoperatively and other 9 patients have undergone surgery without stenting. Twelve patients were stented successfully but 3 patients could not be stented (underwent percutaneous nephrostomy). All 24 patients underwent laparotomy, and of the 12 stented patients, 11 underwent successful resection and one had unresectable tumor. The patient’s serum creatinine was assessed initially and then twice after stenting (48 h and 5 days). Serum creatinine was also estimated 24 h after excision of the tumor. In the successfully stented and operated patients, mean initial creatinine was 7.85. The mean creatinine at 48 h and 5 days after stenting was 4.29 and 1.19 respectively. The mean creatinine 24 h after resection of the tumor was 1.04. Of the non-stented patients, 3 had ureteric injury during surgery. We conclude that preoperative ureteric stenting is helpful for optimization of patients with retroperitoneal tumors with obstructive uropathy.

Muscle cramps are characterized by sudden, painful involuntary contraction of the muscles. The cramps sometimes become disabling and the prevalence is more in the elderly. The etiology of the cramps are diverse and some time the cramps are idiopathic. There are many underlying pathophysiological disorders like hypocalcemia, hypomagnesemia, hypothyroidism, and hepatorenal dysfunction which causes muscle cramp. Similarly, diabetes mellitus results in muscle cramps due to electrolytic imbalance, hypoglycemia, peripheral arterial insufficiency, and neuropathies. Persistent muscle pain in diabetic patients degrades the quality of life of those patients. Although the pathophysiology and etiology of the muscle cramp are understood to some extent, the same is less explored from diabetes mellitus perspective. Hence the objective of this review is to explore the underlying factors responsible for muscle cramps in diabetes so that proper strategy for pharmacotherapy can be made to manage this condition.

Background. Peaks and nadirs of blood glucose level varying daily in a person is referred to as glycemic variability (GV). GV associated with diabetics has been recently linked to cardiovascular disorders (CVD) or even chronic kidney disease (CKD) progression. Faster-acting insulin aspart is the latest ultra-rapid acting bolus insulin which has shown much lesser intra- and inter-patient variability as compared to conventional bolus insulin. Material and methods. However, inadequate data exist regarding GV in patients with advanced stages of CKD. Hence, with this objective, the present case study was undertaken with eight patients divided into two equal groups, wherein faster-acting insulin aspart and insulin aspart were used as the boluses, respectively. Continuous glucose monitoring data of the patients were taken for the initial four days to calculate mean amplitude of glycemic excursion (MAGE) of the total four days for each individual (mmol/L) to see the difference in GV. A value of > 3.607 mmol/L (65 mg/dL) was considered to be statistically significant. Results. In this case study of eight stage 4 CKD type 2 diabetic patients, statistically significant lower GV was observed in the faster-acting insulin aspart arm when compared with the insulin aspart arm. The pvalue was 0.0004 in unpaired t-test and < 0.05 for U in Mann-Whitney U test after ruling out the baseline confounding factors. Conclusions. This study confirms the stable pharmacokinetic and dynamic properties of faster-acting insulin aspart and subsequent studies with larger numer of patients are required for a conclusive outcome.

Introduction. Hypertension is commonly occurring in type 2 diabetes and metabolic syndrome and inflammation are a well-known part of this disease entity. The data of using remogliflozin in Indian patient is not known as this is a very recently approved molecule for the treatment of type 2 diabetes. Here we look into a case series of five patients who had their ambulatory blood pressure monitoring (ABPM) done at baseline and again after 14 days of therapy of adding remogliflozin etabonate to recent onset antihypertensive druges. Methods. We analysed the ABPM results of five patients after taking their informed consent at baseline and two weeks post-treatment initiation with remogliflozin alongside with recent onset antihypertensive drugs. We used paired t test for statistical analysis of the two readings of each patient to come to a conclusion. Results. We found a statistically significant decrease in mean arterial pressure (MAP) reflected by a p value of 0.0277 and the reduction in mean awake time systolic blood pressure (SBP) was also very close to statistical significance as seen by the p value of 0.0541. Conclusions. Remogliflozin etabonate when co-prescribed with antihypertensive drugs shows a significant reduction in MAP as well as reduction in SBP although most of the contribution seems to be coming from the antihypertensive molecule itself.

Coronavirus disease 2019 (COVID-19) reinfections are now reported from many countries with different coronavirus strains. Detectable immunoglobulin G (IgG) levels are thought to impart protective immunity to reinfection in that individual. Here, we discuss a case report of a young, healthy, type 2 diabetic patient who suffered reinfection even after four times upper normal circulating IgG antibody specific to a COVID-19 spike protein. The first time was a clinical diagnosis when he self-isolated himself and was diagnosed later by COVID-19-specific symptoms with severe acute respiratory syndrome coronavirus 2 (SARS-COV-2)-specific IgG antibody titer.

IntroductionWith over 87,273,380 cases being reported and 1,899,440 deaths worldwide as of 9th January 2021, Coronavirus disease 2019 (COVID-19) has become the worst-hit pandemic till date. Every day clinicians are bombarded with many new treatment options that claim to be better than the others.Materials and methodsAfter screening the electronic database of COVID-19 patients retrospectively, 56 patients with mild COVID-19 infection matched the inclusion criteria and were divided into the four following groups - group having used Hydroxychloroquine (HCQ), group using doxycycline (DOX) + Ivermectin (IVR) combination, group receiving only azithromycin (AZ) and, group receiving only symptomatic treatment. The study’s primary objective was to see Clinical response of well-being (CRWB) reporting time after initiating treatment onset between the four different treatment arms.ResultsCRWB did not differ between the four groups receiving four different managements (p-value 0.846). There was significant correlation between blood levels of LDH (p-value 0.001), CRP (p-value 0.03) and D-dimer (p-value 0.04) with CRWB in IVR+DOX group and, between LDH (p-value 0.001), CRP (p-value 0.01) and age (p-value 0.035) with CRWB in the symptomatic management group.ConclusionMild COVID-19 infection in patients having low-risk to progress can be managed symptomatically without any specific drug intervention.

Belonging to the innate immune system, natural killer (NK) cells play crucial roles in various kinds of cancers and other pathologies. The function and development of NK cells are regulated and enhanced by various inflammatory cytokines like common-γ chain family cytokines, transforming growth factor-β, interleukin (IL)-3, IL-10, IL-12, and IL-18. It has been found that their activity, as measured by interferon gamma assay release method, is decreased in Type 2 diabetes mellitus (T2DM) as well as prediabetes and is directly related to the degree of glycemic control. The multiple mechanisms shown by sodium-glucose cotransporter inhibitors (SGLT2Is) to address glycemic as well as non-glycemic inflammatory pathways make them an ideal candidate in most of our obese patients with T2DM since most of them are at higher cardiovascular (CV) risk. Obesity, a common comorbidity in T2DM, is also a known contributor of decreased NK cell activity. Since SGLT2Is have an indirect anti-inflammatory property, hence this study is intended to investigate any change in the NKC activity after initiating empagliflozin over 4 weeks in a cohort of well-controlled diabetic population.

Coronavirus disease 2019 (COVID-19) has played havoc on this world's health and economics since its outbreak in December 2019. Reverse transcription-polymerase chain reaction (RT-PCR) has been the gold standard to diagnose severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Still, few false-positive reports are emerging up that add to the physicians' dilemma and maintenance of health statistics.

IntroductionDecreased workout during coronavirus disease 2019 (COVID-19) is a serious issue for the patients with type 2 diabetes (T2DM), since their glycaemic control is very much related to that. COVID-19 has posed a severe health issue that is playing havoc on the aged patients with existing comorbidities. Studies have shown mixed reports of social media on T2DM, with some showing positive results due to increased use of apps and adherence to lifestyle, while others have shown adiposity and glycaemic control related to hours spent on-screen time in children. Data on adult T2DM patients’ screen time activity and prevailing glycosylated haemoglobin (HbA1c), fasting blood sugar (FBS) and, post-prandial blood sugar (PPBS) is sparse.AimTo study the effect of screen-time spent on social media per day on glycaemic parameters of T2DM patients.Materials and methodsData was collected for T2DM patients giving informed written consent and meeting a set of pre-specified inclusion criteria. Through two rounds of surveys done from May 15 to June 26, the authors collected the answers to a set of questionnaires from a total of 344 patients sent via email. Due to the non-availability of data from a few patients, a total of 229 patients’ data were finally analyzed. SPSS software version V21 ® was used to perform Binary logistic regression for calculating the odds ratio (OR) of the categorical variables. The outcomes, looked for in the analysis, were poor control of glycaemic parameters like HbA1c (defined by >7%), FBS (defined by >150 mg/dL) and, PPBS (defined by >200 mg/dL) and the exposure variables were Screen time spent by the person per day for all the three glycaemic parameters and, doctor’s visit and, daily exercise for HbA1c outcome.ResultsA total of 173 patients had a screen time (henceforth, it means time spent on social media) of less than 2 hours/day in the study sample. Among the 173 patients, 73 (42.2%) had achieved HbA1c less than 7%, whereas the remaining 100 (57.8%) had HbA1c more than 7%. On the other hand, 56 patients had a screen time of more than 2 hours, of which 44 (72.73%) had HbA1c more than 7%. Among the 173 patients, only 89 (51.44%) had an FBS value of more than 150 mg/dL as compared to 46 (82.12%) with a screen time of more than 2 hours. Out of these 173 patients, only 43 (24.86%) had a PPBS value of more than 200 mg/dL as compared to 41 (73.21%) with a screen time of more than 2 hours. It was found that the odds of having a poor glycaemic control as per HbA1c, FBS and PPBS is 2.67 times higher (95%CI: 1.91-6.95), 4.34 times higher (95%CI: 1.52-4.76) and, 8.26 times higher (95%CI: 4.26-11.83) in the cohort with a screen time of more than 2 hours as compared to the cohort with a screen time of less than 2 hours, respectively.ConclusionThere seems to be an increased risk of uncontrolled glycaemic indices with increased screen time and, decreased work out. This is a small study and the findings need to be corroborated with larger sample size.

Current development around the pandemic of novel coronavirus disease 2019 (COVID-19) presents a significant healthcare resource burden threatening to overwhelm the available nationwide healthcare infrastructure. It is essential to consider, especially for resource-limited nations, strategizing the coordinated response to handle this crisis effectively and preparing for the upcoming emergence of calamity caused by this yet-to-know disease entity. Relevant epidemiological data were retrieved from currently available online reports related to COVID-19 patients. The correlation coefficient was calculated by plotting dependant variables - the number of COVID-19 cases and the number of deaths due to COVID 19 on the Y-axis and independent variables - critical-care beds per capita, the median age of the population of the country, the number of COVID-19 tests per million population, population density (persons per square km), urban population percentage, and gross domestic product (GDP) expense on health care - on the X-axis. After analyzing the data, both the fatality rate and the total number of COVID-19 cases were found to have an inverse association with the population density with the variable - the number of cases of COVID-19 - achieving a statistical significance (p-value 0.01). The negative correlation between critical care beds and the fatality rate is well-justified, as intensive care unit (ICU) beds and ventilators are the critical elements in the management of complicated cases. There was also a significant positive correlation between GDP expenses on healthcare by a country and the number of COVID-19 cases being registered (p-value 0.008), although that did not affect mortality (p-value 0.851). This analysis discusses the overview of various epidemiological determinants possibly contributing to the variation in patient outcomes across regions and helps improve our understanding to develop a plan of action and effective control measures in the future.

The new novel coronavirus COVID-19 is playing havoc on the healthcare system of the whole world and various preventive measures have been suggested by various bodies. The use of medical masks has been cited as the most crucial step in prevention. Healthcare workers are now exposed to this disease and are forced to use medical masks for prolonged hours during their duty period. The normal oral and nasal microbiome might get affected due to this prolonged mask use and hence this study is carried out to look for any such change.

Introduction: Obesity and metabolic syndrome have been long inter-linked and it has been found that the cardiovascular (CV) mortality increases steadily with the increase in obesity as defined by increase in body mass index (BMI). The BMI cut-off for defining obesity is different in Asians as compared to Caucasians where we consider BMI 24.9 as normal. In Asians we use a BMI value of 23 as the upper normal due to the increased CV mortality and higher degree of chronic kidney disease (CKD) as defined by decreased age-specific estimated glomerular filtration rate (eGFR) seen in Asians.

Background Despite conventional insulin treatment being considered an effective approach for glycemic regulation during renal dysfunction, there is still a major clinical need for better insulin therapy to stabilize fluctuations in glucose levels. Aim The aim of this study was to assess the impact of mealtime fast-acting insulin aspart therapy on glycemic variability as compared to regular human insulin therapy in advanced chronic kidney disease (CKD) patients with type 2 diabetes (T2D). Methods Data from eight patients were retrospectively collected after analyzing 57 patients' data between July 2019 and October 2019. All T2D patients with stage 4 CKD were switched to mealtime fast-acting insulin aspart on account of recurrent hypoglycemic events. The continuous glucose monitoring data of the first four days were analyzed to calculate the mean amplitude of glucose excursions (MAGE) as well as five other glycemic variability indices, namely, standard deviation, mean, continuous overall net glycemic action, average daily risk range, and J index. Results The primary endpoint of 24-h MAGE significantly decreased from 7.01 ± 2.59 to 4.19 ± 1.06 mg/dL (p = 0.012) when short-acting regular human insulin (RHI) therapy was replaced with mealtime fast-acting insulin aspart therapy. However, no significant change was observed in 24-h mean glucose levels and other indices of glucose variability. Significant reduction in 24-h and night-time hypoglycemic events was reported in patients after therapy switch during the four-day follow-up period. Conclusions The present study demonstrated an improvement in glycemic variability with the administration of fast-acting insulin aspart as compared to RHI, suggesting that modern bolus insulin replacement might prove to be a useful therapeutic strategy in type 2 diabetes patients with advanced CKD. Further clinical studies will be required to confirm the benefits of this therapeutic approach. Relevance for patients The safety and effectiveness of fast-acting insulin aspart in CKD patients have not yet been established. The clinical effectiveness and better safety profile of newer mealtime insulin therapy may prompt a reconsideration of its use in patients with an advanced stage of renal dysfunction, leading to better adherence and improved quality of life.

Metabolic disorders are characterized by pathologies like visceral adiposity, hypertension, type 2 diabetes mellitus (T2DM), dyslipidemia, impaired glucose tolerance, fatty liver, and so on, with insulin resistance being the main contributing factor. Insulin resistance and diabetes mellitus are commonly associated with elevated triglyceride levels. Among the available medications for treating metabolic disorders, only Saroglitazar has a dual peroxisome proliferator-activated receptor ɑ + γ action that can reduce high triglycerides and improve insulin sensitivity. This medication may also reduce liver fibrosis content. The present case report illustrates the efficacy of Saroglitazar in reducing hypertriglyceridemia and liver stiffness as assessed by shear wave elastography.

Background Diabetes is a metabolic, non-communicable disease (NCD) that represents one of the major causes of morbidity and mortality worldwide. India has a huge burden of chronic kidney disease (CKD) that is associated with diabetes. Materials and methods Cross-sectional data were collected for a total of 241 patients from the authors' clinic record. A new approach for the management of patients with diabetes was proposed using a grid system, where we need to consider the Hemoglobin A1C (HbA1c) and estimated glomerular filtration rate (eGFR) values of the patient and assign a zone (green, blue, orange or red) and subsequently decide an appropriate treatment according to the assigned zone. Results We found that 20.73% of patients had decreased eGFR and only 31.12% of patients achieved target HbA1c level. A high prevalence of diabetic nephropathy (20.73%) was observed in this study population. A statistically significant difference among the four groups (zones) with respect to age (p

Background Patients with non-alcoholic fatty liver disease (NAFLD) are often insulin resistant. Several recent studies show NAFLD to be associated with cardiovascular risk. Bioimpedance analysis (BIA) is a common approach for body composition measurements and is a noninvasive, low-cost modality. Shear-wave elastography (SWE) works using an acoustic radiation force pulse sequence that generates shear-waves that estimates the liver stiffness. Objectives The primary objective was to assess the correlation between SWE values and BIA values in an Indian population. The hypothesis is that with the increase in BIA value measuring visceral fat percentage, the SWE value measuring liver stiffness should increase. Materials and methods We conducted a retrospective analysis of clinic data of 36 patients properly screened from July 2018 to December 2018, who matched our prespecified inclusion criteria. Statistical analysis was performed using GraphPad Insta Version 3.0® using regression analysis. Visceral fat percentage and skeletal muscle percentage of lower limbs were calculated using an Omron HBF 375® analyzer. SWE values for liver fat were measured using a Philips Affinity 70® using two-dimensional imaging and expressed in kilopascal (kPa) units. Results We found that 88.88% of the patients with diabetes had above normal SWE values (2.0 to 4.5 kPa), and a corresponding 83.33% of patients had above the high cut-off for BIA values (>10%) but without any positive correlation between the two parameters as evident from the p-value of 0.079. Conclusions This study found a high prevalence of fat burden amongst our patients with type 2 diabetes and NAFLD. This is the first of its kind of study where we searched for a correlation between the two commonly used parameters in assessing the fat burden and liver stiffness of an individual but found there was no significant correlation between the two parameters used.

There is no Indian data at present on sodium-glucose cotransporter 2 (SGLT2) inhibitors' role on glycated haemoglobin A1c (HbA1c), weight, and blood pressure in non-diabetic individuals. This novel mechanism of action could assure us of sustained non-glycaemic benefits along with information on the negligible risk of hypoglycaemia. The aim was to observe the changes of various parameters using canagliflozin (300 mg) in a non-diabetic person suffering from hypertension and dyslipidaemia (on treatment for two years). Canagliflozin (300 mg) once-daily was administered for 13 weeks with a continuous glucose monitoring system (CGMS) installed to assess glycaemic changes and tests done at baseline: four, eight, and 13 weeks. A dyslipidaemic and hypertensive with a family history of type 2 diabetes (T2D) (mother) and hypertension (father), the patient was currently using antihypertensive and statin therapy for two years. Over a period of 13 weeks, there was a reduction in weight by 3.2 kg; body mass index (BMI) by 1 Kg/m2, visceral fat by 1.5%, waist circumference by 5 cm, uric acid level by 63.01%, and increase in bone mineral density (BMD) (as opposed to decrease seen with SGLT2Is in other studies). There was no episode of hypoglycaemia. Our study has given rise to certain critical issues regarding the early use of canagliflozin (although on an off-label basis) in patients who are at high risk of developing diabetes in the future.

Dengue is considered the most prevalent mosquito-borne viral disease worldwide and sometimes turns out to be life-threatening. Thrombocytopenia is frequently observed in mild and severe cases of dengue. Severe thrombocytopenia, with a platelet count much below the normal range and hemorrhagic manifestation, is considered a fatal consequence of dengue that needs proper and timely management. The development of the dengue vaccine is quite challenging due to the existence of four different serotypes of the virus. Currently, neither a specific antiviral therapy nor a vaccine is available, and the common treatment modalities include fluid replacement therapy and platelet transfusions. Besides dengue, thrombocytopenia is correlated with many other diseases, particularly immune thrombocytopenic purpura (ITP). Thrombopoietin receptor (TPO-R) agonist, which is responsible for increasing platelet count, is a novel treatment option for chronic ITP patients. At present, two TPO-R agonists - eltrombopag and romiplostim - approved by the US Food and Drug Administration (USFDA) have been successfully used for the treatment of chronic ITP and other thrombocytopenic conditions. However, to date, only a single case study reported the use of romiplostim to enhance the platelet count in a myeloma patient suffering from dengue-associated thrombocytopenia. The objective of this review is to propose to the medical fraternity to consider using these TPO-R agonists to treat dengue hemorrhagic patients with thrombocytopenia and to conduct relevant researches to find out the usefulness of these molecules. This review is completely based on hypotheses and articles showing the positive response with romiplostim in dengue after going through a web-based search on various search engines. Furthermore, this review highlights the need for good-quality, randomized controlled trials and meta-analyses to detect the safety and efficacy of romiplostim and eltrombopag therapy for patients suffering from dengue-related thrombocytopenia.

Introduction: In renal transplantation, there is end-to-side anastomosis of renal artery to external iliac artery and end-to-end anastomosis of renal artery to internal iliac artery. The end-to-end internal iliac artery anastomosis can be associated with complications due to compromised distal vascular supply to limbs and penile erectile tissue. A method of end-to-side anastomosis can overcome them. Till date, there is no case series or trial that has studied the effect of end-to-side anastomosis. This study is aimed at comparing the outcome of end-to-side and end-to-end anastomosis, so as to evaluate the efficacy of end-to-side technique. Materials and Methods: A total of 40 renal transplant recipients were taken, with internal iliac artery anastomosis, and were divided into two groups, 20 patients with end-to-end and 20 patients with end-to-side anastomosis. The cold ischemia time, arterial anastomosis time, post-operative bleeding and urine leak, claudication, saddle anesthesia and erectile dysfunction, and follow-up recipient creatinine and eGFR and Doppler to look for graft renal artery patency (at 6 months post-transplant) were compared between the two groups. Results: The intraoperative cold ischemia time was slightly more in the group with end-to-end anastomosis, but it was statistically significant (P = 0.22). The arterial anastomosis time was comparable in both the groups (P = 0.65). In the end-to-end group, 15%, 20% and 15% patients had post-operative saddle anaesthesia, claudication and mild-to-moderate erectile dysfunction, which were absent in the end-to-side group. On follow-up, the mean recipient serum creatinine and eGFR were comparable in the two groups. Also, the graft renal artery patency on Doppler was comparable. Conclusion: The end-to-side technique can be definitely applied for renal transplantation, with some advantages over end-to-end technique, and without compromising efficacy.

Objective Optical internal urethrotomy is a feasible modality of treatment for short segment bulbar urethral strictures. Recurrence is an important problem after urethrotomy. This study aimed at evaluating the efficacy of oral steroid (deflazocort) in reducing the recurrence of strictures after urethrotomy. Up to date, no study has evaluated the role of oral steroids after urethrotomy. Material and methods In this case-control study, patients undergoing urethrotomy (bulbar urethral strictures

The complexes [PdCl2(pap)] (1) and [PtCl2(pap)] (2; pap = 2-phenylazopyridine) were synthesized by treating PdCl2 or K2PtCl4, respectively, with pap and characterized by 1H NMR spectroscopy and elemental analysis. Both these complexes, together with the previously reported complex [(az)Pd(μ-Cl)2Pd(az)] (3; az = azobenzene), were also characterized by X-ray crystallography. The structures of 1, 2, and 3 show a slightly elongated N–N azo double bond due to back-donation from the metal centers and a twisting of the uncoordinated part of the ligands with respect to the rest of the molecule. Cyclic voltammetry of 1, 2, 3, and the related complex [(az)Pt(μ-Cl)2Pt(az)] (4) shows reduction processes which are reversible for 1 and 2 but irreversible for 3 and 4. The first reduction of 1 and 2 leads to radical complexes, and EPR spectroscopy shows the spin to be predominantly located on the azo part of the complexes. The radical complex 2·– shows an unprecedented 195Pt hyperfine coupling constant and g anisotropy for such PtII radical species. The UV/Vis spectroscopy results for all the complexes are also discussed.(© Wiley-VCH Verlag GmbH & Co. KGaA, 69451 Weinheim, Germany, 2009)

Context: Various methods are used for gender identification in anthropologic and forensic investigations. The canine tooth is widely used for gender determination because of its sexual dimorphism and durability in the oral cavity. Mandibular canine index (MCI) is one of the most reliable and valid predictor for gender identification. Aim: To assess the reliability of MCI in gender determination in Indian population. Settings and Design: This was an experimental study involving the preparation of plaster models of 100 individuals residing in Udaipur, Rajasthan, India. Of these 45 were males and 55 were females. Both sexes were in the age group of 20–30 years. Study casts were prepared for all individuals and the measurements of mandibular canine teeth were taken. The MCI was calculated using standardized equation. In addition, the percentage of sexual dimorphism was calculated. Statistical Analysis Used: Independent sample t-test was used. P < 0.05 was considered statistically significant. Results: There was a significant difference (P < 0.05) observed between inter-canine distance, right and left canine width and right and left MCI between males and females. Sexual dimorphism is more on left permanent mandibular canine teeth than right permanent mandibular canine teeth. The overall percentage of accuracy observed was 85.5%. Conclusions: Study findings reveal that MCI can be used a reliable predictor for gender determination in Indian population and can form the basis of anthropologic and forensic investigations.

Introduction: Diabetes mellitus is a chronic heterogenous disease in which there is dysregulation of carbohydrates, protein and lipid metabolism; leading to elevated blood glucose levels. The present study was conducted to evaluate the correlation between blood glucose and salivary glucose levels in known diabetic patients and control group and also to evaluate salivary glucose level as a diagnostic tool in diabetic patients. Materials and Methods: A total number of 250 patients were studied, out of which 212 formed the study group and 38 formed the control group. Result: Among 250 patients, correlation was evaluated between blood glucose and salivary glucose values which on analysis revealed Pearson correlation of 0.073. The p-value was 0.247, which was statistically non significant. Conclusion: Salivary glucose values cannot be considered as a diagnostic tool for diabetic individuals.

Neutral diastereoisomeric diruthenium(III) complexes, meso- and rae-[(acac)(2)Ru(mu-adc-OR)Ru(acac)(2)) (acac(-) = 2,4-pentanedionato and adc-OR2- = dialkylazodicarboxylato = [RO(O)CNNC(O)OR](2-), R = tert-butyl or isopropyl), were obtained from electron transfer reactions between Ru(acac)(2)(CH3CN)(2) and azodicarboxylic acid diallcyl esters (adc-OR). The mew,P isomer 3 with R = isopropyl was structurally characterized, revealing two deprotonated and N-N coupled carbamate functions in a reduced dianionic bridge with d(N-N) = 1.440(5) angstrom. A rather short distance of 4.764 angstrom has been determined between the two oxidized, antiferromagnetically coupled Ru-III centers. The rac isomer 4 with R = isopropyl exhibited stronger antiferromagnetic coupling. While the oxidation of the neutral compounds was fully reversible only for 3 and 4, two well-separated (10(8) < K-c < 10(10)) reversible one-electron reduction steps produced monoanionic intermediates 1(-)-4(-) with intense (epsilon approximate to 3000 M-1 cm(-1)), broad (Delta nu(1/2) approximate to 3000 cm(-1)) absorptions in the near-infrared (NIR) region around 2000 nm. The absence of electron paramagnetic resonance (EPR) signals even at 4 K favors the mixed-valent formulation Ru-II(adc-OR2-)Ru-III with innocently behaving bridging ligands over the radical-bridged alternative Ru-II(adc-OR center dot-)Ru-II, a view which is supported by the metal-centered spin as calculated by density functional theory (DFT) for the methyl ester model system. The second reduction of the complexes causes the NIR absorption to disappear completely, the EPR silent oxidized forms 3(+) and 4(+), calculated with asymmetrical spin distribution, do not exhibit near infrared (NIR) activity. The series of azo-bridged diruthenium complex redox systems [(acac)(2)Ru(mu-adc-R)Ru(acac)(2)](n) (n = +,0,-,2-), [(bpy)(2)Ru(mu-adc-R)Ru(bpy)(2)](k) (k = 4+,3+,2+,0,2-), and [(acac)(2)Ru(mu-dihR)Ru(acac)(2)](m) (m = 2+,+,0,-,2-; dih-R2- = 1,2-diiminoacylhydrazido(2-)) is being compared in terms of electronic structure and identity of the odd-electron intermediates, revealing the dichotomy of innocent vs noninnocent behavior.

The heterodinuclear compound [(PhenQ)Cu(dppf)](BF(4)), PhenQ= 9,10-phenanthrenequinone and dppf = 1,1'-bis(diphenylphosphino)ferrocene, was identified structurally and spectroscopically (NMR, IR, UV-vis) as a copper(l) complex of a completely unreduced ortho-quinone. Crystallographic and DFT calculation results suggest that this stabilization of a hitherto elusive arrangement is partially owed to intramolecular pi/pi interactions phenyt/PhenQ. Intermolecular PhenQ/PhenQ pi stacking is also observed in the crystal. According to DFT calculations, the pi interactions are responsible for the considerably distorted coordination geometry at Cu(1) with one short and one longer Cu-O and Cu-P bond, respectively, and with bond angles at copper ranging from 99 degrees to 133 degrees. Electrochemical reduction proceeds reversibly at Low temperatures to yield an EPR spectroscopically characterized semiquinone-copper(I) species.

A 64 years male farmer presented with history of painless gross hematuria for 1 month and severe loss of weight and appetite for 2 months. There was a history of single episode of fever for 1 day without chills and rigors, about 1 month ago. There was no history of tuberculosis. On examination patient had severe pallor, no raised temperature and no tenderness at renal angle. His hemoglobin on admission was 5.7gm%. Enhanced CT scan showed right kidney having irregular low density lesion at the lower pole with perirenal fluid collection. Urine for culture sensitivity showed growth of Escherichia coli sensitive to norfloxacin and so patient was put on oral norfloxacin for 14 days. A CT guided fine needle aspiration biopsy was planned for the patient for a definite diagnosis. But a repeat ultasonography before the procedure, showed both kidneys to be normal. The lesion had vanished!Bangladesh Journal of Medical Science Vol. 12 No. 03 July ’13 Page 339-340 DOI: http://dx.doi.org/10.3329/bjms.v12i3.11793

Health and intelligence are two closely related aspects of human well being. Nutrition, including iron levels, affects cognitive function and thereby may influence the occupational performance of an individual. Inadequate nutrition during adulthood may lead to decreased work efficiency, poor exercise tolerance and increased susceptibility to infections. The profession of dentistry requires keen recognizing abilities and decision making skills as well as ample physical stamina, which may be impaired in a state of malnourishment. Keeping this in view, this study was designed to assess the possible impact of iron levels on cognitive function among dental students. In this study 206 dental students (150 females and 56 males) participated and their cognitive functioning was determined by answering a questionnaire. The questionnaire evaluated the confidence level, work pattern and the tendency to be distracted by the physical environment of the study participants. Iron status was determined by estimating the hemoglobin level of the individuals. Each of the three cognitive traits was correlated with hemoglobin levels. The results revealed that that majority of dental students had good levels of confidence, work patterns with a low level of restriction and low levels of distraction by the physical environment. No significant correlations were found between any of the cognitive parameters and hemoglobin levels (p>0.05) in female participants. In male participants significant correlations were found in two out of three cognitive functioning tests, confidence levels and work pattern (p