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Background Interleukin 6 (IL-6) encoded by the gene coded as IL 6 acts as a proinflammatory cytokine as well as an anti-inflammatory myokine. It is postulated that IL 6 is associated directly with the severity of coronavirus disease-2019 (COVID-19). Another domain that is thought to predict the severity of COVID-19 is the neutrophil:lymphocyte (N:L) ratio; a higher N:L ratio is postulated to be related to more severe outcomes. Thus, the present study was aimed to establish a correlation of COVID-19 with IL-6 in terms of clinical outcomes. We had also tried to find the relationship between IL-6 and N:L ratio and high-resolution computed tomography (HRCT) score. Methods We have conducted a cross-sectional study of 200 patients who were admitted to the intensive care unit (ICU) with reverse transcriptase-polymerase chain reaction (RT-PCR) positive for COVID-19 from January to May 2021. Serum IL-6, N:L ratio, and HRCT chest were conducted on admission. Result Out of 200 patients who were admitted to the ICU with COVID-19, while the IL-6 was higher in patients with increased N:L ratio and HRCT score, the association of IL-6 with clinical outcomes in terms of discharged and expired was found to be statistically not significant. Conclusion Serum IL-6 was found not to be a potent marker for clinical outcomes in ICU patients in terms of death vs survived. However, the IL-6 levels on admission can be correlated with the computed tomography (CT) severity scores as well as N:L ratio of patients admitted to an ICU. How to cite this article Talwar D, Kumar S, Acharya S, Raisinghani N, Madaan S, Hulkoti V, et al. Interleukin 6 and Its Correlation with COVID-19 in Terms of Outcomes in an Intensive Care Unit of a Rural Hospital: A Cross-sectional Study. Indian J Crit Care Med 2022;26(1):39–42.

Necrotizing fasciitis is infrequently encountered but highly fatal group of infections. It is a infection of any of the three layers of soft tissue compartments which includes the dermis, subcutaneous tissue, superficial fascia,deep fascia or the muscle along with necrotising changes. During the initial stages it might be tricky to differentiate cellulitis and other infections of the superficial skin from necrotising fasciitis leading to an delay in the diagnosis. Prompt diagnosis and management can reduce mortality .This case report highlights a previously unreported presentation of necrotising fasciitis of breast in the form of leukemoid reaction encountered in the rural central India following COVID-19 infection.

Dengue is a viral illness spreads through the bite of Aedes aegypti mosquito leading to a serious health hazard. Dengue induced acute kidney injury is a fatal consequence and there are very few studies reported. Hence early identification of high risk groups is crucial for prevention, to restrict progression and effective treatment of acute kidney injury and to minimise associated morbidity and mortality. The coronavirus disease outbreak has widely spread into a pandemic all over the world. COVID-19 cases have presented with wide spectrum of severity ranging from a mild presentation to severe cases affecting the lungs(ARDS) mainly and rapidly affecting various body organs leading to multiorgan failure. Among these renal involvement is common, the severity of which ranges from mild loss of protein in urine to progressive acute kidney injury requiring renal replacement therapy.

Ferritin overload is a frequent problem encountered in patients with beta thalassemia amounting to various complications. One of rare but important complication of ferritin overload is ferritin overload induced toxic encephalopathy. Serum ferritin has been recognised as a important marker of inflammation and cytokine storm in COVID19.We present a case of Long COVID syndrome presenting as toxic encephalopathy in a case of beta thalassemia in spite of the patient being compliant to desferroxamine therapy.This report highlights the synergistic effect of Severe Acute Respiratory Syndrome Coronavirus. 2(SARS CoV 2) mediated neuroinflammation through direct viral invasion and the release of inflammatory cytokines including ferritin resulting in toxic encephalopathy in a beta thalassemia major patient who was already prone to develop hyperferritenemia.Ferritin functions as a pro-inflammatory cytokine and it’s level increases in both thalassemia and COVID-19 and the index case presented here had both the conditions predisoposing him to develop toxic encephalopathy even after being compliant to deferoxamine therapy. It is important to recognise and treat this condition in order to prevent mortality and morbidity in patients of beta thalassemia who contract COVID19.

ECAST Or exercise collapse associated with sickle cell trait is a rare phenomenon associated with sickle cell trait and is an important presentation of sickle cell disease in sports medicine. Collapse is seen following vigorous physical activity, which is due to excessive heat, dehydration and other factors associated with physical exercise. This rare syndrome is often missed by the treating physicians as a result of a lack of knowledge about this rare entity leading to massive underreporting. It is important to identify ECAST as a cause of the collapse in young athletes to prevent mortality and morbidity and in order to provide prompt treatment. We report a case of a 25- year-old young male who was a bodybuilder and reported to the gym after a one-year-long break due to lockdown restrictions of COVID19. After a vigorous exercise session, he collapsed in the gym and was brought to the emergency department. After proper history taking and examination, he was suspected to be a case of ECAST due to a history of a similar episode three years back which was treated as a case of exertional syncope with intravenous fluid therapy and a family history of Sickle cell trait with his mother and father both having sickle cell AS Pattern. Ultimately our patient turned out to be a case of Sickle Cell Trait with evidence of AS pattern on Hb electrophoresis and a small-sized spleen visualized on CT Scan of the abdomen. The patient was managed successfully with intravenous fluids and blood transfusion and was discharged in a stable condition. He was counseled about moderating his exercise and is doing well on follow-up.

Rodenticide is the term given for the compounds that are used in the killing of rats. The commonest compounds that are available as rodenticides are Aluminum phosphide, Zinc Phosphide, Yellow Phosphorus and Coumarins. Due to their easy availability in the general stores, these also have been used as a source of inflicting self-harm by the patients in order to commit suicide. Most of the patients escape the poisonous side effects with a mild course, but some cases progress to a state of Acute liver failure or fulminant liver failure. Due to the broad range of symptoms that can occur with the compounds, it is important to discuss the course of progression of symptoms from mild to severe in order to understand the treatment protocols to treat the patient appropriately. Some patients progress to such a severe form of symptoms that there is an urgent indication of liver transplantation. Here we report a case of rodenticide poisoning in a young female which started off with a mild course and ultimately progressed to fulminant liver failure leading to a fatal outcome.

With increasing incidence of Severe Acute Respiratory Distress Virus 2(SARS -CoV -2) in India, there has been growing reports of super infections in post covid 19 period. Long COVID refers to persistence of COVID19 symptoms for weeks to months. While most common manifestation of long COVID is fatigue and ill health, it may lead to development of life-threatening complications like Pulmonary Mucormycosis. We report a case of 54 year young, non-diabetic previously healthy male who had moderate COVID19 treated with low dose steroids and recovered completely, only to present with hemoptysis 3 months later on High Resolution Computed Tomography Scan of the Chest and Rhizopus fungi on bronchoalveolar lavage confirming Post Covid Pulmonary Mucormycosis in non-immunocompromised host. Patient was managed with dual antifungal therapy intravenous Liposomal Amphotericin B and Posaconazole for 3 weeks, followed by oral Posaconazole. J MEDICINE 2021; 22: 150-154

Non-invasive Ventilation (NIV) has emerged as an useful aid for management of pulmonary diseases specifically in cases of respiratory failure. NIV provides respiratory support without the need of an endotracheal tube, helping in avoiding the complications associated with intubation such as tracheal trauma, infection, bleeding, injury to the lung tissues and aspiration. NIV has turned out to provide substantial benefit in the management of chronic obstructive pulmonary disease, acute respiratory distress syndrome, cardiogenic pulmonary edema and in cases of neuromuscular disorders. It has now become an integral tool in the management of respiratory failure, both at home as well as hospital settings including critical care units. All patients of respiratory failure irrespective of causes likeAcute exacerbations of COPD, Acute pulmonary edema, Exacerbations of cystic fibrosis, asthma, or restrictive lung disease and Pneumonia admitted in intensive care unit/high dependent units are suitable for NIV. Noninvasive ventilation is standard of care in chronic respiratory failure and has replaced invasive ventilation in such settings. Its flexibility in use and ease of administration allows it to be acceptable by patients as well as caregivers.

As the pandemic continues to spread vigorously, it is being noted that the COVID 19 virus is associated with various complications during the disease and also a great deal of post disease sequel.1 These gruelling complications are integrated with the overwhelming infection caused by the cytokine storm produced by the virus. While the treatment modalities are still under trial, glucocorticoids seem to have played a pivotal role in putting a check to the inflammation caused by the virus and have forbidden the organ damage caused thereafter. However, the aftermath of glucocorticoids usage has its own benefits and risks. Glucocorticoids cause cellular immunodeficiency and thus have immunosuppressive effects, additionally the use of immunomodulators such as tocilizumab alters the immune system and it subsequently predisposes the host to various secondary opportunistic infective agents. In the current state, as the pandemic abstains from fading away, an increasing trend of secondary fungal infections has been seen with COVID-19, resulting in an outbreak of fungal infections such as mucormycosis and candidiasis. Mucormycosis refers to any infection caused by the fungi of the Order Mucorales. Mucormycosis has been documented in the literature to be associated with a high rate of mortality due to its potential to spread drastically.2 Altered immunity is an important risk factor for mucormycosis. Additionally, diabetes has been noted to be critical for the development of mucormycosis in immunocompetent patients. Candidiasis is an infection caused by the candida species due to the immunosuppressed state developed by the use of glucocorticoids, which results in secondary fungal infection requiring urgent medical attention. The objective of this case report is to highlight the impending secondary fungal infection outbreak in COVID-19 and the need to contain this emerging spread of fungal infections under the blanket of this deadly pandemic.

The present study investigates the micromechanical properties of ceramic coated WC/Co tools and their influence on wear performance during dry Ti6Al4V turning. Physical and micromechanical characterization have been performed for the evaluation of the PVD coating properties. Higher hardness, elastic modulus, and adhesion strength have been obtained for dual-layer (AlTiN/AlCrN) coated tool than monolayer AlTiN and AlCrN coated tools. Micromechanical properties influence the wear mechanisms in thermally activated and abrasion dominant crater zones. Dual-layer coated tools reduced the flank wear at the corner radius and crater wear by 35–50% and 40%, respectively. Dynamic wear and abrasion-dissolution wear mechanisms have been explored over the tool rake face. Dual-layer coatings have improved wear performance by diminishing delamination, micro-fracturing of WC grains, binder dissolution and fractured interface boundaries.

With the rapid spread of severe acute respiratory syndrome SARS-CoV2, the incidence of the disease is increasing each day with a higher infectivity rate and unpredictable morbidity and mortality. The second wave in India has higher morbidity and mortality compared to the previous wave of SARS-Cov2. With the increasing trend of screening hypoxic patients with high resolution computed tomography (HRCT) of thorax, treatment modalities, and investigational approaches have changed drastically. Here we report a case of a 31-year-old female who presented to a tertiary care centre in the rural area with a history of fever five days back and a history of breathlessness of 3 days duration and dry cough of 3 days duration. She was hypoxic on admission and later on diagnosed with SARS-Cov2 infection. HRCT thorax revealed a CT severity score of 25/25. She was treated according to standard treatment protocols. The patient was discharged after 46 days with normal oxygen saturation on room air. The aim of this case study is to emphasize the wholesome approach in the management of COVID-19.

We present a case of term pregnancy which presented with chief complaint of Breathlessness, chest pain as well as a one day history of vomiting. She tested positive for COVID19 through reverse transcriptase polymerase chain reaction of nasopharyngeal swab and the symptoms were attributed to Pneumonia caused due to COVID19.However,the arterial blood gas showed metabolic acidosis with high anion gap. This was a non lactate acidosis with no hypoxemia. Most reasonably the state of pregnancy with increased energy demands along with increased metabolic maternal demand due to infection coupled with maternal starvation had resulted in this Ketoacidosis . In view of non progression of labor caesarian section was carried out and a healthy neonate was delivered. There was an initial improvement in maternal ketoacidosis post partum however optimal management of COVID19 pneumonia required oxygen support and use of corticosteroids. Thus we highlight how an unusual metabolic demands of pregnancy might mimic COVID 19.

Incidence of Dengue has been on the up rise ever since the second wave of the pandemic of COVID19 has ended introducing an old enemy on the frontline to the health care professionals.A 28 year old Gravida 2 Parity 0 Living 0 Abortion 1 with twin pregnancy presented with fever along with chills and retro orbital pain along with body ache since two days in the emergency department with the gestational age of 36 weeks.She tested positive for Dengue NS1 antigen.Patient was having thrombocytopenia and was managed with intravenous fluids,platelet and blood transfusion and was taken for caesarian section and she delivered twins with normal birth weight.During the post operative period the patient went into dengue shock syndrome and which was managed with fluids and inotropic support and patient ultimately recovered and was discharged on day seventeen of admission .This case report emphasises on the importance of prompt detection and management of dengue in a case of high risk pregnancy such as twin pregnancy.After extensive review of literature we found that this is the first case report to report the association of twin pregnancy with dengue shock syndrome making it an important topic of discussion.

Background Hypertensive disorders during pregnancy are an important topic of concern, specifically in rural and remote areas of India where there is a lack of awareness and it is difficult to maintain proper follow-up of pregnant females to screen them for complications developed during pregnancy. Gestational hypertension and pre-eclampsia result in the abruption of the placenta, hemolysis, elevated liver enzymes, low platelet count syndrome, eclampsia, and disseminated intravascular coagulation, which can be a serious threat to the health of the mother and the fetus. Therefore, it is important to identify biomarkers for diagnosing and predicting the complications of pre-eclampsia that may aid the obstetric high-dependency units based in rural areas to tackle this important health hazard during pregnancy. Methodology A total of 180 singleton pregnant women of more than 34 weeks of gestational age were enrolled in this study. All women were divided into three groups (control group, severe pre-eclampsia, and non-severe pre-eclampsia) based on the severity of blood pressure and the presence of proteinuria (≥+1 by the dipstick method). Salivary and serum uric acid levels were measured through morning samples, and all patients were monitored for the development of complications and outcomes. Salivary uric acid and serum uric acid levels were correlated with each other and with maternal complications of pre-eclampsia. Results Mean salivary uric acid (mg/dL) in severe pre-eclampsia was (6.72 ± 0.49) significantly higher compared to non-severe pre-eclampsia (4.75 ± 0.94) and control (3.13 ± 0.43). Mean serum uric acid (mg/dL) in severe pre-eclampsia was (8.13 ± 0.87) significantly higher compared to non-severe pre-eclampsia (6.23 ± 0.76) and control (3.85 ± 0.46).The lowest best cut-off value of maternal salivary uric acid was 5.06 mg/dL, above which one can predict maternal complications with a diagnostic accuracy of 78.33%. Conclusions Salivary uric acid and serum uric acid levels are significantly raised in cases of pre-eclampsia in comparison to normal pregnancy. Salivary uric acid and serum uric acid are correlated significantly indicating that salivary uric acid can function as a cost-effective, novel marker to provide an idea about serum uric acid levels. The prognostic accuracy of salivary uric acid was good in predicting maternal complications among cases of pre-eclampsia (severe and non-servere) and early-onset maternal complications. Therefore, it may be utilized as a helpful marker to identify high-risk patients.

Background There is a continual rise in the prevalence of non-cancerous conditions such as chronic kidney disease (CKD) owing to an enormous load of diabetes, hypertension, and vascular diseases. A positive attitude and healthy lifestyle for CKD prevention can only be followed when the masses are well aware and educated about the disease. This study aimed to compare, correlate, and evaluate the distribution of knowledge, attitudes, and perceptions among relatives or caretakers of patients with kidney disease or at risk of the disease. Methodology This cross-sectional study aimed at obtaining data on the knowledge, attitudes, and perceptions using the Chronic Kidney Diseases Screening Index questionnaire from the relatives of CKD patients. All data were computed and analyzed using SPSS version 28.0 (IBM Corp., Armonk, NY, USA). Results The majority of the relatives of CKD patients had poor knowledge (63.6%) and poor attitude (51.6%) levels. On the contrary, most respondents had good practices (52.8%) level toward the risk for CKD. A significant correlation was noted between education and knowledge (p0.050). A significant association was also observed between education and occupation with attitude (p0.001 and p0.050, respectively). Additionally, a significant association was noted between age and perception (p0.001). Conclusions Informed and well-educated populations are less prone to acquire or progress to CKD. From this study, we can understand the need for improvement in public knowledge, which has the potential to help in saving the lives of many patients progressing toward end-stage renal diseases.

Pregnancy is considered one of the most delicate conditions for the woman and her fetus, rendering physiological stress on her body. Sometimes, this leads to unwelcomed incidences of certain systemic disorders which further complicate the course of pregnancy. Cardiovascular conditions associated with pregnancy have major morbidity amongst the general population. Peripartum cardiomyopathy, one such condition associated with cardiac dysfunction during pregnancy, is one of the major causes of increased morbidity and mortality in pregnant women. It has been the leading cause of non-obstetric maternal mortality. Due to the stress on the cardiovascular system, further functioning of the body in the milieu gets compromised and thus, the occurrence of fetomaternal mortality is not rare in the prognosis of this condition. Certain studies have noted not only familial but also geographical variations in the prevalence of peripartum cardiomyopathy in certain areas. Although the occurrence of the condition is quite common, there still needs to be a better understanding of this topic for avoiding the abysmal prognosis of this pathology. A peculiar presentation on the electrogram is needed to make an accurate diagnosis of the condition. The therapeutic options of this condition, particularly incline towards medical management. Various new drugs have been formulated and are in clinical trials for testing their effectiveness. Bromocriptine therapy, along with the neoadjuvant combination of anticoagulant drugs and non-pharmacological measures, makes a good treatment regimen that helps avert the progressive pathology. In this article, we discuss the knowledge regarding the etiology, factors contributing to the severity, pathogenesis, treatment options, and the particular outcomes of the therapy.

Laurence Moon Bardet Biedl syndrome (LMBBS) / Bardet–Biedl disorder (BBS) is an uncommon hereditary disease that is autosomally recessive. It is described by obesity, mental hindrance, dysphoric furthest points (syndactyly, brachydactyly, or polydactyly), retinal dystrophy or retinitis pigmentosa, hypogonadism, and renal abnormalities (among the prevailing aspects).1 LMBBS shares its similarities with Oliver McFarlane syndrome [OMS]. Many patients experienced a gradual loss of vision as a result of retinitis pigmentosa. In retinitis pigmentosa, initially, patients will have night blindness which can be progressed into colour blindness and tunnel vision. Patients of LMBBS may have taurodontism, the condition in which the tooth’s body is greater than the roots.2 Patients of LMBBS can develop chronic renal failure.3 Other features such as brachycephaly, learning disability and gait ataxia can be found in LMBBS patients.

Angioedema is an intense often disfiguring but temporary swelling of a localized area which usually involves superficially lying structures like skin, mucosa along with subcutaneous tissues. Areas which are often affected by angioedema have a wide range starting from the face, lips, tongue, pharynx, the supraglottic area and rarely, the subglottic area. It might also effect the gastrointestinal mucous membranes, genitalia, hands and feet. There maybe variety of causes for development of angioedema including various drug intake, insect bites or stings and certain types of food products particularly nuts, milk and eggs. Levamisole is known to have anthelminthic and immunomodulatory properties and is a common contaminant in cocaine due to its mood stimulatory action. Here we report a case of a 60-year-old female who presented with angioedema following ingestion of a drug known as levamisole for its anthelminthic activity. Keywords: Angioedema, Swelling, Reaction, Levamisole, Elderly

Introduction Coronavirus disease 2019 (COVID-19)has been a difficult enemy to beat for healthcare professionals around the world. However, even before the end of the COVID-19 pandemic, there has been an emergence of a new combatant in the form of opportunistic fungal infections with a high rate of morbidity and mortality, creating havoc throughout the globe. Methods A case-control single-center study was conducted in Datta Meghe Institute of Medical Sciences, Wardha, Maharashtra. All the subjects who were included in the study were tested positive for COVID-19 through the reverse transcriptase-polymerase chain reaction (RT-PCR) method and the cases were defined as patients with biopsy-proven mucormycosis, whereas control were subjects who did not develop mucormycosis. The duration of the study was three months, from June 2021 to August 2021. Result A total of 55 cases and 50 controls were enrolled in the study. The use of zinc was found to be significantly associated with COVID-19-associated mucormycosis, with 89.1% of the cases having a history of zinc intake and only 52% of controls having a history of zinc intake( p-value0.001). Diabetes mellitus was found to be significantly associated with COVID-19-associated mucormycosis with 83.6% of the cases and 16% of the controls having diabetes mellitus (p-value0.001). Although the use of steroids in cases was more with 98.2% of the cases and 54% of the control receiving steroids; this difference was not significant statistically (p-value of 1.00). Conclusion We conclude that apart from diabetes mellitus and other immunosuppressive states, zinc might be the hidden culprit behind the sudden surge of COVID-19-associated mucormycosis worldwide owing to the self-administration of zinc by the patients to acquire innate immunity and over-prescription of multivitamins by the treating clinicians. However, this association required further studies in order to be proved.

Objective The present study was undertaken to study the utility of high-resolution computed tomography (HRCT) temporal bone in live patients for providing the parameters of ossicular dimensions (OD), using standard assessment protocols, devised by the authors, with regard to the plane of CT scans and axes of measurement of ossicles. Methods This observational study was conducted from January 2021 to February 2022 at Acharya Vinoba Bhave Rural Hospital, Sawanghi, Meghe, Maharashtra, India, in the Department of Otorhinolaryngology and Department of Radiodiagnosis. HRCT scan was performed on temporal bones, 10 in live subjects with no otological complaints and 10 in cadaveric temporal bones. HRCT was also performed for all three ossicles after dissecting them out from the respective cadaveric temporal bones. Measurements of OD were taken using Universalmednet Software and vernier calipers and compared with published anatomic data. Results The measurements taken using HRCT scans of the live subject and cadaveric bone as well as the ossicles taken using calipers fall within the range of published studies. Slight variation is seen in the measurements of stapes and incus, stapes total height is 3.17mm, less than 3.3. Conventional HRCT temporal bone in live patients when performed under set circumstances can be adopted as a standard method for measurement of ossicular sizes for the generation of normative data for different races, ethnicity and sex. Conclusion The results of our study can have implications in terms of translational research as the measurements obtained can help in better understanding of middle ear biomechanics, prosthesis designing, developing ideal tympanoplasty methods in terms of size, shape and placement of autograft.