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The earliest evidence from China suggested that COVID-19 patients are even more vulnerable to succumbing from complications in the presence of a multimorbid status, including metabolic syndrome. Due to ongoing metabolic abnormalities, non-alcoholic fatty liver disease (NAFLD) appears to be a potential risk factor for contracting SARS-CoV-2 infection and developing related complications. This is because of the interplay of chronically active inflammatory pathways in NAFLD- and COVID-19-associated acute cytokine storm. The risk of severe disease could also be attributed to compromised liver function as a result of NAFLD. We systematically reviewed current literature to ascertain the relationship between NAFLD and severe COVID-19, independent of obesity, which is considered the major factor risk factor for both NAFLD and COVID-19. We found that NAFLD is a predictor of severe COVID-19, even after adjusting for the presence of obesity (OR 2.358; 95% CI: 1.902-2.923, p < 0.001).

The serum osmolar gap, defined as the difference between measured osmolality and calculated osmolarity, is a convenient method to screen for toxins in serum. In normal circumstances, the difference between the two is 6-10 mol/kg. Typical contributors to serum osmolarity are sodium bicarbonate, sodium chloride, glucose and urea. An elevated gap, defined as a difference10 mol/kg, can occur if a sufficient quantity of an additional solute other than those mentioned above is present in the serum or there are inaccuracies in sodium measurement secondary to hyperlipidaemia and hyperproteinaemia. An elevated serum osmolar gap should thus prompt clinicians to check for toxic alcohol levels. Treatment with fomepizole should not be delayed if suspicion is high. Isolated diabetic ketoacidosis can occasionally present with an elevated osmolar gap in the absence of concomitant alcohol ingestion. This finding is attributed to the production of acetone and glycerol. We describe the case of a 62-year-old man presenting with diabetic ketoacidosis/hyperosmolar hyperglycaemic state and an elevated osmolar gap in the absence of toxic alcohol ingestion.The osmolar gap is the difference between the measured and the calculated serum osmolarity and should be calculated in all patients presenting with elevated serum osmolarity; if elevated, toxic alcohol ingestion should be considered and prophylactic treatment with fomepizole immediately administered if the index of suspicion is high.Although toxic alcohol ingestion is one of the common causes of an elevated osmolar gap, hyperlipidaemia, hyperproteinaemia and less occasionally lactic acidosis and ketoacidosis have also been implicated.In the setting of ketoacidosis, the osmolar gap can be elevated in the absence of toxic alcohol ingestion, is attributed to increased production of acetone and glycerol, and is responsive to treatment with insulin and intravenous fluids.

The World Health Organization recognized SARS-CoV-2 as a public health concern and declared it as a pandemic on March 11, 2020. Over 12 million people have been affected across several countries since it was first recognized. SARS-CoV-2 is thought to commonly spread via respiratory droplets formed while talking, coughing, and sneezing of an infected patient. As several cases, with an absence of travel history to the majorly affected areas were identified, a strong possibility of community transmission could have been possible. Broadly, two modes of transmission of COVID-19 exist-direct and indirect. The direct mode includes (1) transmission via aerosols formed via surgical and dental procedures and/or in the form of respiratory droplet nuclei; (2) other body fluids and secretions, for example, feces, saliva, urine, semen, and tears; and (3) mother-to-child. Indirect transmission may occur via (1) fomites or surfaces (e.g., furniture and fixtures) present within the immediate environment of an infected patient and (2) objects used on the infected person (e.g., stethoscope or thermometer). As many of these modes may be underestimated, it is necessary to emphasize and illustrate them. The goal of this paper is to briefly review how SARS-CoV-2 is shown to transmit via various modes and propose measures to reduce the risk of spread within the population and operating personnel.

The severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), the causative agent of the novel coronavirus disease 2019 (COVID 19), was reported to the World Health Organization in late 2019. This disease quickly evolved into a public health concern and was declared a pandemic on March 11, 2020. COVID-19's high transmission rate and potential to cause a spectrum of systemic diseases makes it imperative for researchers and clinicians worldwide to collaborate and develop a strategy to manage and contain this disease. Studies have shown a wide range of hematological abnormalities and virus-related coagulopathies in affected patients, resulting in an increased propensity to develop serious thrombotic complications or disseminated intravascular coagulation (DIC) in severe cases. The fatal implications of coagulopathy in the form of pulmonary embolism (PE), myocardial infarction (MI), and cerebral infarction compelled us to study in-depth the pathophysiology and treatment options related to COVID-19. This analysis reviews published reports on patients with confirmed SARS-COV-2 infection and associated coagulopathy, defined as abnormalities in the coagulation parameters prothrombin time (PT), activated partial thromboplastin time (aPTT), antithrombin time, fibrinogen, fibrin degradation products, and D-dimer. In this review, we present the hematological manifestations of COVID-19, focusing on virus-associated coagulopathy and relevant pathophysiology, clinical outcomes, and treatment.

Whether weather plays a part in the transmissibility of the novel Coronavirus Disease-19 (COVID-19) is still not established. We tested the hypothesis that meteorological factors (air temperature, relative humidity, air pressure, wind speed and rainfall) are independently associated with transmissibility of COVID-19 quantified using the basic reproduction rate (R0). We used publicly available datasets on daily COVID-19 case counts (total n = 108,308), three-hourly meteorological data and community mobility data over a three-month period. Estimated R0 varied between 1.15 and 1.28. Mean daily air temperature (inversely), wind speed (positively) and countrywide lockdown (inversely) were significantly associated with time dependent R0, but the contribution of countrywide lockdown to variability in R0 was over three times stronger as compared to that of temperature and wind speed combined. Thus, abating temperatures and easing lockdown may concur with increased transmissibility of COVID-19 in India., Graphical abstract Unlabelled Image, Highlights • We tested association of geo-socio-meteorological factors with COVID-19 in India. • Air temperature, wind speed and lockdown were independently associated with R0. • Countrywide lockdown contributed to COVID-19 more strongly than weather factors.

Background: Thyroid disorders are common in India. Symptoms and signs of thyrotoxicosis are nonspecific. Graves disease is an autoimmune condition and is the most common cause of thyrotoxicosis. Cardiovascular system is frequently affected in thyroid disorders but there is not much data on prevalence of thyrotoxicosis and related cardiovascular morbidities in central India. Objectives of study the clinical profile of patients with thyrotoxicosis and outline the related cardiovascular manifestations in a tertiary care center. Design-over a period of nine months a descriptive cross sectional study was conducted in a tertiary health care center.Methods: A total of 150 patients with thyrotoxicosis were studied. Patients with known diagnosis of thyrotoxicosis and newly diagnosed cases were included. The participants were investigated for thyroid profile, Electrocardiogram, Complete blood count, serum electrolytes and kidney function test.Results: Out of 150 patients of thyrotoxicosis, 87 (58 %) were diagnosed with Graves’s disease. Hypertension was observed in 78 (52 %) of participants. Atrial fibrillation was found in 18 (12%) and sinus tachycardia in 53 (35.33 %) of the participants.Conclusion: Grave’s disease is the commonest cause of thyrotoxicosis. Hypertension, sinus tachycardia and Atrial Fibrillation are the common cardiovascular diseases observed to be associated with thyrotoxicosis.

Background: Deep vein thrombosis is a disease of potentially serious consequences and is still often unsuspected. The present study was undertaken to look into etiological factors, management approaches and complications in patients presenting primarily with DVT at a tertiary care centre.Methods: This was a descriptive study profiling 75 confirmed DVT cases admitted at a tertiary care government hospital over two years. Detailed assessment included thorough clinical examination, duplex venous ultrasound and basic investigations, along with special investigations and CT angiography in selected few. Appropriate management was provided, and details recorded. Patients were followed up clinically and by ultrasound after 1 week, 2 weeks and 3 months. The complications, if any were also recorded.Results: The mean age of participants was 39.5±14.4 years, with 28% between 30-39 years. Majority (40%) did not have any obvious predisposing factor and most of them presented with pain and swelling. Most (52%) of the cases had involvement of both proximal and distal veins, 45.33% cases had involvement of only proximal veins whereas only 2.67% had restricted involvement of distal veins. Around 60% of cases have complete clinical resolution and approximately 50% cases have complete ultrasonographic resolution at the end of 3 months.Conclusions: Young adults without any obvious risk factors may develop and present with DVT and hence factors leading to thrombosis in them are recommended to be thoroughly evaluated. Duplex venous ultrasound is reliable non-invasive diagnostic modality and is recommended for diagnosis of DVT in clinically suspected cases.

Background: Incidence of Right Ventricular Myocardial Infarction (RVMI) associated with Inferior Wall Myocardial Infarction (IWMI) is reported to be quite high (30%-50%). To diagnose coexisting RVMI is important, since its early recognition and proper treatment reduces overall morbidity and mortality in IWMI. Author assessed the incidence and clinically profiled patients with right ventricular infarction in acute inferior wall myocardial infarction and analysed the effects of RVMI on clinical outcome of IWMI.Methods: A total of 150 patients of IWMI were evaluated in the present hospital based prospective observational study over duration of two years. They were evaluated for coronary risk factors like diabetes mellitus, hypertension, smoking, obesity, alcohol and dyslipidemia. Twelve-lead ECG, cardiac enzyme assay and echocardiography were undertaken in all the participants.Results: Of the total 150 patients, 45 (30%) patients had right ventricular myocardial infarction (RVMI). Complications were significantly lower in patients with isolated IWMI as compared to patients with IWMI and associated RVMI except pulmonary edema (p