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Brock’s syndrome or middle lobe syndrome (MLS) is chronic or recurrent collapse of right middle lobe due to causes which may be obstructive or non obstructive. The pathogenesis is not completely understood. An expert committee of the world health organization defined cor pulmonale as hypertrophy of the right ventricle resulting from diseases affecting the function and/or structure of the lungs.” Cor pulmonale is a common heart disease and a leading cause of disability and death. We are reporting this association in a 65y old female who presented to the emergency with acute exacerbation of COPD with SpO2=64% room air. Chest X-ray and HRCT thorax showed features suggesting MLS and ECG shows features suggesting P pulmonale /right atrial enlargement. BNP too was elevated. Patient was resuscitated and put on mechanical ventilation after ABG showed respiratory acidosis. Appropriate treatment with bronchodilators and antibiotics was given.

Importance: Neovascular glaucoma (NVG) is a severe form of secondary glaucoma has a varying prevalence of 0.01 to 3.9% of all glaucoma in different regions of world. Majority of them are affected with proliferative diabetic retinopathy. Although NVG overall prevalence is low but it is a dreadful condition led to blindness. If not detected earlier of the disease by latest investigating majors and treated systematically on different stages of the disease along with taking care of the alleviation of different aggravating factors for retinal hypoxia. Objectives: To summarize published evidence on etiopathogenesis, clinical feature, stages of NVG and to provide treatment recommendation on different stages of the NVG for ophthalmologists based on published evidence. Evidence Review: A literature search of PubMed was conducted from January 1, 1974 to June 30, 2022. Publications describing prevalence, etiopathogenesis, clinical staging, investigation and treatment modality were included in the study. Findings: NVG is characterized by development of new vessels on iris and fibrovascular tissue proliferation in the anterior chamber angle with increase in IOP, principally driven by Retinal ischemia and among the commonest causes are proliferative diabetic neuropathy (PDR), central retinal venous occlusion, and ocular ischemic syndrome (OIS).

The study presents the effectiveness of Reinforced Concrete (RC) jacketed columns in enhancing the seismic performance of a five-story RC frame. The performance of the structure is examined using a non-linear static method also known as pushover analysis. The retrofitting approach used in this study is a local level approach and its effect on the global behavior of the frame. SAP 2000 has been used to perform the analysis for the frames before and after jacketing the columns. The sequence of hinges formation has been studied for both frames. The change in ductility capacity and elastic stiffness before and after jacketing of the columns is obtained using bilinear curves. Both the structural parameters calculated for existing and jacketed structures showed a substantial increase in their respective values after jacketing. Variation of base shear for both the frames is obtained using capacity curves or pushover curves. The pushover curve obtained as a result of static nonlinear analysis indicated a considerable increase in the strength of the jacketed frame which is almost double the capacity of the existing frame.

Whenever a member of a structure becomes structurally deficient, it becomes vulnerable to the existing load and for the additional loads that it may be subjected to in the coming future. Since columns are the most important structural element, the structural retrofit of columns, relative to other structural elements is of prime importance. This study intends to investigate the performance and behaviour of an RC column jacketed with Reinforced Concrete columns under axial loads. The objective of this paper is to find out the efficiency of RC jacket in enhancing the strength of an existing RC column. A mathematical design based upon Indian Standards codes has been designed to identify the behaviour of jacketed RC columns. This has been followed by a finite element based numerical simulation using the same material properties as used in the process of designing. The simulation has been done in ABAQUS software with appropriate contact modelling. The analytical model considers that there is no bond slippage between the existing and new concrete surface i.e. the bond between the existing and new concrete is assumed to be perfect. This perfect bond between the surfaces has been modelled by using appropriate constraints in ABAQUS software. The finite element models show fair agreement with the designed values in terms of ultimate capacity and failure mode. The load bearing capacity enhancement of the RC jacketed column has been found to increase substantially. The enhancement capacity results obtained from the finite element software differs about 16-25% from the design values.

Objectives: The outbreak of 2019 Novel coronavirus disease (COVID-19) has caused global attention. Due to its rapid spread worldwide, COVID-19 was declared as a public health emergency by the World Health Organization. Although most patients have mild symptoms and good prognosis, severe COVID-19 cases may present with acute respiratory distress syndrome (ARDS) and systemic inammation. Thus, it is to evaluate the disease severity and investigate possible biomarkers so as to make fast and correct clinical decisions. Methods: This is a single center, prospective study conducted at Nalanda Medical College and Hospital Patna. We enrolled 100 OPD and inhospital patients with COVID- 19 admitted to the Nalanda Medical College and Hoapital and analyzed infection biomarkers in covid patients who had been tested for ferritin, PCT, CRP, IL-6 and procalcitonin. Results:Average level of Ferritin in Covid-19 patients is 18746.34 ng/ml whereas in control patients it is around 226.29 ng/ml. Around 97 percent of patients affected with COVID-19 having Ferritin level very high from the referred range. Average level of D-dimer in Covid patients is 2807.16 ng/ml and in non COVID patients 276.04 ng/ml. All the covid patients have D-dimer level very high than the referred range. Average level of Procalcitonin in Covid and control patients is 0.93 and 0.53 ng/ml respectively. Around three fourth of covid patients and one third of control patients have this level higher than the referred range. CRPlevel of COVID patients are very high (on an average 483.48 mg/l) in comparison to non covid patients (on an average 6.29 mg/l). All the covid patients have IL-6 level much higher than the referred range. Conclusion: Our ndings suggest that level of Ferritin, D-dimer, PCT, CRP and IL-6 can be used to predict the result of COVID-19 test. They can help in detection of COVID-19 patients.

Aim: To determine the rate of mortality in critically ill COVID-19 positive diabetic patients and association with mortality and length of hospitalization. Methods: Retrospective Cohort Study done at Nalanda Medical College and Hospital in 670 patients. Critically ill COVID-19 positive (RT-PCR proven) (>= 18yrs), either gender, attending MICU, NMCH Patna included in the study. Results: The mortality rate of patients was 31% where as patients aged above 40 yrs were having significantly higher odds [OR(95% CL)=5.64 (1.56-20.43)] of mortality Increasing age by 10 years showed significantly higher odds [OR(95%CL)= 1.55 (1.15-2.07)] of mortality. An Insignificant association was found between diabetes and mortality in patients. The length of hospitalization in diabetic patients was higher [median =10(6,16)] than non- diabetic patients [median=7(2,12)] (p=0.036). The mean age of patients in MICU, NMCH was 51 years with 71 % patients aged more than 40 yrs. The patients had a male predominance 31 % patients were Diabetic. 106 patients were diagnosed as T2DM patients after their MICU admission. 29 % patients were Hypertensive and 23 % patients had both T2DM and HTN, 74 % patients had shortness of breath as C/F whereas only 58% patients had fever, RBS level on admission had no significant association [OR(95%CL)=0.882(0.730-1.067)] with mortality Glycemic variability had no significant association [OR(95%CL)=1.000(0.925-1.082)] with duration of hospitalization. A statistically significant association was seen between T2DM and HTN (p=0.01) in COVID-19 patients. A significant (p=0.008) proportion (90.3%) of diabetic patients were aged above 40 years as compared to nondiabetic patients. Conclusion: COVID-19 patients attending NMCH patna have male preponderance. With increasing age, mortality increases in COVID-19 critically ill patients. Diabetes does not increase mortality in COVID-19 patients but increases the length Of hospitalization. Disclosure A. K. Sinha: None. D. Pandey: None. M. Madhukar: None. R. K. Topno: None. R. Kumar: None. S. K. Sinha: None.

Background: Remogliflozin had recently got approval in India as new SGLT2i and also there was a storm of Vildagliptin generics after it loses its exclusive marketing patent. Method: This was a 48 weeks prospective observational study (N=254, age ≥ 35 years with HbA1c ≥ 7%). According to investigator decision, eligible patients were assigned either remogliflozin 100 mg BD ( N=980) or Vildagliptin 50 mg BD (N= 1420) in patients who were initially uncontrolled on metformin 1000 mg alone in single or divided doses for atlas 6 weeks. Primary outcome was change in HbA1c, FBS and PPBS, secondary outcome was proportion of patients with HbA1c Results: Initially 300 patients were selected but 254 patients completed the study. At baseline, mean age was 57.8±6.3 years, HbA1c 8.2±1.2%, BMI 30.1±1.7 kg/m2, and diabetes duration 5.2±1.2 years. Mean HbA1c, FBS and PPBS was significantly reduced in both the group (p0.05). However, mean HbA1c% was slightly more reduced in remogliflozin plus metformin group (-1.2±0.3%; 8.1±1% to 6.9±0.5%, p>0.001) than vildagliptin plus metformin (-1±0.3%;8.3±1.3% to 7.3±0.6%, p>0.001). 62% patients on remogliflozin were achieved target HbA1c level within 24 weeks where as it was 57% with vildagliptin group. Differences were found in: SBP -7.92 mmHg (p Conclusion: In conclusion, both therapies yielded similar improvements in glucose control. However, the adherence was better with remogliflozin. Disclosure A. K. Sinha: None.

The progressive nature of type 2 diabetes mellitus (T2DM) renders the shifting of patients from oral drugs to insulin therapy an inevitability in most patients especially in those with long duration of diabetes. At the turn of the last millennium, neutral protamine Hagedorn (NPH) insulin was still the only long-acting insulin available for people with diabetes. The advent of the first truly long-acting basal insulin, i.e. insulin glargine 100 U/mL (Gla-100) brought to the table a remarkably long duration of action and a very minimal risk of hypoglycemia by due to less pronounced peaks in their action profile. Further, in trying to achieve fasting normoglycemia, Gla-100 has demonstrated remarkably more holistic glucose-lowering efficacy in several pivotal trials compared to other insulin formulations, such as premixed insulin and coformulations-apart from NPH insulin. This article delineates clinical data on the effectiveness of Gla-100 vs. other insulin formulations in the context of T2DM.

Objective Mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene are associated with pituitary adenoma, acromegaly and gigantism. Identical alleles in unrelated pedigrees could be inherited from a common ancestor or result from recurrent mutation events. Design and methods Observational, inferential and experimental study, including: AIP mutation testing; reconstruction of 14 AIP-region (8.3 Mbp) haplotypes; coalescent-based approximate Bayesian estimation of the time to most recent common ancestor (tMRCA) of the derived allele; forward population simulations to estimate current number of allele carriers; proposal of mutation mechanism; protein structure predictions; co-immunoprecipitation and cycloheximide chase experiments. Results Nine European-origin, unrelated c.805_825dup-positive pedigrees (four familial, five sporadic from the UK, USA and France) included 16 affected (nine gigantism/four acromegaly/two non-functioning pituitary adenoma patients and one prospectively diagnosed acromegaly patient) and nine unaffected carriers. All pedigrees shared a 2.79 Mbp haploblock around AIP with additional haploblocks privately shared between subsets of the pedigrees, indicating the existence of an evolutionarily recent common ancestor, the ‘English founder’, with an estimated median tMRCA of 47 generations (corresponding to 1175 years) with a confidence interval (9–113 generations, equivalent to 225–2825 years). The mutation occurred in a small tandem repeat region predisposed to slipped strand mispairing. The resulting seven amino-acid duplication disrupts interaction with HSP90 and leads to a marked reduction in protein stability. Conclusions The c.805_825dup allele, originating from a common ancestor, associates with a severe clinical phenotype and a high frequency of gigantism. The mutation is likely to be the result of slipped strand mispairing and affects protein–protein interactions and AIP protein stability.

Background: Acute exacerbation of chronic bronchitis in COPD (AECB) is the major cause of morbidity, mortality and marked reduction in quality of life and imposes significant burden on both patients and healthcare systems. Bacterial infections causing AECB frequently require antibacterial treatment, so more evidences are needed to guide better antibiotic choice. Objective of the study was planned to compare efficacy and safety of Garenoxacin, a new fluoroquinolone versus moxifloxacin for treatment of Acute exacerbation of Chronic bronchitis in COPD patient.Methods: This was a prospective open label comparative study done in department of pharmacology and T.B & Chest of Government Medical College attached Dr Shusila Tiwari Hospital, Haldwani. 60 subjects with clinical symptoms suggestive of Anthonisen type II AECOPD (any two of following criteria: Increased dyspnea, cough, sputum purulence) were enrolled and randomized to receive either Moxifloxacin 400 mg once daily for 7 days or Garenoxacin 400mg once daily for 7 days. The primary outcome measure was clinical success rate at day 7 visit. Secondary outcome measures were changes in clinical global impression (CGI) scales and incidence of adverse events.Results: The mean age of patient was 60.98±9.9 years and 57.9±9.3 years in the Moxifloxacin and Garenoxacin groups. The clinical success rates were comparable with 86.2% in moxifloxacin group 84.6% and in garenoxacin group. Adverse effects were mild and self limiting. We observed two adverse effects in garenoxacin and three in moxifloxacin group.Conclusions: The result of study showed that garenoxacin is comparable to moxifloxacin in terms of efficacy and safety.

BackgroundFree radical activity is an important cause of vascular complications in type 1 diabetes mellitus. But data regarding vascular complications in type 2 diabetes mellitus are scant.ObjectivesThe aim of this study was to examine free radical activity in type 2 diabetic patients with hypertension compared to those without hypertension.Materials and MethodsThe serum levels of lipid peroxidation product, MDA malondialdehyde), the free radical scavenger, SOD (superoxide dismutase) and NO (nitric oxide) were studied in 50 type 2 diabetic outpatients. Controls were regarded as those diabetic outpatients who did not have hypertension.ResultAmong 50 patients thus studied 19 were hypertensive. The concentration (median (range)) of both SOD (21.31(5.33–26.64) vs. 16.65(6.66–22.64)U/dl; p

Management of airway in trauma victim with penetrating cervical/thoracic spine injury has always been a challenge to the anaesthesiologist. Stabilisation of spine during airway manipulation, to prevent any further neural damage, is of obvious concern to the anaesthesiologist. Most anaesthesiologists are not exposed to direct laryngoscopy and intubation in lateral position during their training period. Tracheal intubation in the lateral position may be unavoidable in some circumstances. Difficult airway in an uncooperative patient compounds the problem to secure airway in lateral position. We present a 46-year-old alcoholic, hypertensive, morbidly obese person who suffered a sharp instrument (screwdriver) spinal injury with anticipated difficult intubation; the case was managed successfully.

There has been an increase in the number of procedures done via the radial route over the last few years; both because of the increase in acceptability among the interventionists and safety and comfort to the patients in terms of reduced incidence of bleeding, hematoma and early mobilization and discharge. We present our experience pertaining to the clinical characteristics, procedural details, hardware used, feasibility and most importantly post-procedural outcomes in terms of radial artery patency in patients undergoing radial intervention at our centre over a period of almost 4 months, in a first of its kind tertiary care centre at Patna.

We report a case of blunt chest injury following a road accident leading to damage of the left main and left anterior descending coronary arteries causing acute myocardial infarction in a young person.

Background: Mixing of various adjuvants has been tried with local anesthetics in an attempt to prolong anesthesia from peripheral nerve blocks but have met with inconclusive success. More recent studies indicate that 8 mg dexamethasone added to perineural local anesthetic injections augment the duration of peripheral nerve block analgesia. Aims: Evaluating the hypothesis that adding dexamethasone to ropivacaine significantly prolongs the duration of analgesia in supraclavicular brachial plexus block compared with ropivacaine alone. Patients and Methods: It was a randomized, prospective, and double-blind clinical trial. Eighty patients of ASA I and II of either sex, aged 16-60 years, undergoing elective upper limb surgeries were equally divided into two groups and given supraclavicular nerve block. Group R patients (n = 40) received 30 ml of 0.5% ropivacaine with distilled water (2 ml)-control group whereas Group D patients (n = 40) received 30 ml of 0.5% ropivacaine with 8 mg dexamethasone (2 ml)-study group. The primary outcome was measured as duration of analgesia that was defined as the interval between the onset of sensory block and the first request for analgesia by the patient. The secondary outcome included maximum visual analogue scale (VAS), total analgesia consumption, surgeon satisfaction, and side effects. Results: Group R patients required first rescue analgesia earlier (557 ± 58.99 min) than those of Group D patients (1179.4 ± 108.60 min), which was found statistically significant in Group D (P < 0.000). The total dose of rescue analgesia was higher in Group R as compared to Group D, which was statistically significant (P < 0.00). Conclusion: Addition of dexamethasone (8 mg) to ropivacaine in supraclavicular brachial plexus approach significantly and safely prolongs motor blockade and postoperative analgesia (sensory) that lasted much longer than that produced by local anesthetic alone.

Current European neonatal resuscitation guidelines (Zideman et al. Resuscitation 1998;37:103–110) advocate cardiopulmonary resuscitation (CPR) at 120 compressions per minute in a ratio of 3:1. This is commonly interpreted as a net rate, thus requiring delivery of 40 breaths per minute, which is the upper end of the range of 30–40 breaths per minute suggested in the guidelines. At least one other interpretation is available, but the correct one is not specified. No studies have evaluated whether the rates inferred by the guidelines can be achieved. This study assesses the ability of trained hospital providers to fulfil these criteria in a simulated arrest scenario. A group of anaesthetists, paediatricians, midwives and neonatal nurses was asked to perform CPR either as single rescuers or in pairs, for 5 min, following European Resuscitation Council guidelines. Breaths and compressions delivered were measured by inductance plethysmography. The number of breaths delivered in the first and fifth minute of the scenario were measured, as well as the quality of delivered breaths. Of 33 single resuscitators, none were able to deliver 40 breaths per minute in either the first minute (range 11–34; median 20; interquartile range 14–26) or the fifth (13–35; 19; 15.25–26.5). Of 18 pairs of rescuers, four achieved 40 breaths per minute in the first minute (24–45; 33.5; 29.75–38.25) but only three of 17 were able to sustain this to the fifth minute (21–48; 35; 30.5–39). One pair did not complete 5 min of resuscitation. Single rescuers were unable to achieve the rate of CPR suggested by current guidelines. Only 22% of paired rescuers were able to achieve this standard in the first minute, falling to less than 20% by the fifth minute. We recommend modifying the guidelines to make them unambiguous and practicable, with the emphasis shifted onto the quality of compressions and ventilations, rather than quantity.