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Background and aims It is not known if new onset diabetes during Coronavirus-19 disease (COVID-19; NOD COVID) is phenotypically or biochemically different than new onset diabetes before COVID-19 (NOD). Methods All adults diagnosed with new onset diabetes from during the time of COVID-19 were compared with new onset diabetes prior to COVID-19, from two tertiary care hospitals in Chennai and Delhi. RTPCR test for SARS-CoV-2 virus was done as appropriate, and COVID-19 antibody test was done in all other NOD COVID patients. Result A total of 555 patients with new onset diabetes were included in the study (282 NOD and 273 NOD COVID patients). Patients with NOD COVID had higher fasting and post prandial blood glucose and glycated hemoglobin vs. NOD patients. Both the groups had high average body mass index; ∼28 kg/m2. Interestingly, fasting C-peptide levels were significantly higher in the NOD COVID group vs. NOD group. There was no difference in C-peptide or glycemic parameters between the COVID-19 antibody positive and negative NOD COVID cases. Conclusion Individuals who were diagnosed with diabetes during COVID-19 epidemic (NOD COVID) do not significantly differ from those diagnosed before COVID-19 in symptomatology, phenotype, and C-peptide levels but they had more severe glycemia., Highlights • We studied 282 patients with new-onset diabetes before COVID-19 (NOD), and 273 new onset patients with diabetes during COVID-19 (NOD COVID). • Patients with NOD COVID had higher fasting blood glucose, post prandial blood glucose and glycated hemoglobin as compared to NOD patients. • There was no difference in C-peptide or glycemic parameters between the COVID-19 antibody positive and negative NOD COVID cases.

The performance of thermoelectric generators (TEGs) besides depending on material’s figure of merit, is also a function of the module design like the heat exchanger design, thermoelectric leg size, configuration, and contact resistances. Optimizing these parameters using conventional experimental methods is quite time-consuming and inconvenient. Taguchi optimization method could be used an efficient technique to predict the performance of a TEG module with less number of experimental runs as compared to the customary techniques. The most commonly used materials in thermoelectric applications in the medium temperature range (400–900 K) are the PbTe alloys and Mg2(Si-Sn) based alloys. N-type Mg2(Si-Sn) alloys often being integrated with higher manganese silicide (HMS) for fabricating TEGs, pose problems in maintaining the long-term stability of such generators owing to the imperfectly matched thermomechanical properties between these materials. Therefore, it is required to evaluate a TEG system that is completely made out of magnesium based thermoelectric alloys (both p- and n-type). The current study examines the scope of Mg2(Si-Sn) thermoelectric generators based on the numerical modeling technique along with employing Taguchi and ANOVA techniques for improving the overall system output. A TEG system comprising of 36 modules is built using numerical modeling which is followed by optimization of pivotal design parameters through the Taguchi and ANOVA methods. Optimal control factor settings obtained from the Taguchi method result in output power and conversion efficiency values of 90.04 W and 9.08% respectively. The predicted optimal output Ypredicted is also calculated, the respective values obtained for output power and conversion efficiency are 59.9 W and 9.12%. From ANOVA analysis, it is observed that the most significant variable for power output is the cross-sectional area with a percentage contribution of 35.22% and that for the conversion efficiency is the temperature difference between the two ends of the TEG having a percentage contribution of 97.73%.

Background Diabetes is recognized as an important comorbidity in patients with COVID-19 and a large amount of literature has become available regarding this. The aim of this article is to review the literature regarding various aspects of association between diabetes and COVID-19 and to highlight clinically relevant points with focus on India. Methods We searched Pubmed and Google Scholar databases for articles regarding diabetes and COVID-19 published between March 19, 2020 and August 30, 2020. Results Diabetes and poor glycemic control are associated with increased severity and mortality in patients with COVID-19. Several clinical scenarios about hyperglycemia and COVID-19 are identified and each of these needs specific management strategies. Conclusion It is prudent to maintain good glycemic control in patients with diabetes in order to minimize the complications of COVID-19. There is a need for well conducted studies to asses the role of individual antihyperglycemic therapies in COVID-19 and also the behavior of new onset diabetes diagnosed either after COVID-19 infection or during this time.

Visually impaired people have to deal with various challenges since they cannot see anything with their eyes and even some visually impaired people are not able to read the content of their interest so they fail to gain knowledge from reading as much as a normal person can obtain. Visually impaired people have some content available in the braille format that they can read but not all content of their reading interest is available in the braille format. Therefore, braille embosser will help to make available the maximum content of their reading interest in the braille format at an affordable cost. In this project, the user will have to upload an image of blinds reading interest, which is to be converted in the braille format. Initially, we will extract the text from a text image and save the text file using different image processing techniques. Then each character stored in the text file will be converted to the respective braille format using ASCII values and then converted text will be embossed using the braille embosser, which will make the content available for the blind community.

Background and aims COVID-19 is already a pandemic. Emerging data suggest an increased association and a heightened mortality in patients of COVID-19 with comorbidities. We aimed to evaluate the outcome in hypertensive patients with COVID-19 and its relation to the use of renin-angiotensin system blockers (RASB). Methods We have systematically searched the medical database up to March 27, 2020 and retrieved all the published articles in English language related to our topic using MeSH key words. Results From the pooled data of all ten available Chinese studies (n = 2209) that have reported the characteristics of comorbidities in patients with COVID-19, hypertension was present in nearly 21%, followed by diabetes in nearly 11%, and established cardiovascular disease (CVD) in approximately 7% of patients. Although the emerging data hints to an increase in mortality in COVID-19 patients with known hypertension, diabetes and CVD, it should be noted that it was not adjusted for multiple confounding factors. Harm or benefit in COVID-19 patients receiving RASB has not been typically assessed in these studies yet, although mechanistically and plausibly both, benefit and harm is possible with these agents, given that COVID-19 expresses to tissues through the receptor of angiotensin converting enzyme-2. Conclusion Special attention is definitely required in patients with COVID-19 with associated comorbidities including hypertension, diabetes and established CVD. Although the role of RASB has a mechanistic equipoise, patients with COVID-19 should not stop these drugs at this point of time, as recommended by various world organizations and without the advice of health care provider., Highlights • There is a high prevalence of hypertension, diabetes and cardiovascular disease in patients with COVID-19. • There is an evidence of increased mortality with these comorbidities in patients with COVID-19, in an unadjusted analyses. • Although theoretically, there is a clinical equipoise on harm or benefit with renin angiotensin system blocker (RASB) in patients with COVID-19, there is not enough evidence to stop RASB in patients with COVID-19 at this moment.

Background and aims In view of restrictions on mobility of patients because of COVID-19 pandemic, face-to-face consultations are difficult. We sought to study the feasibility of telemedicine in this scenario. Methods PubMed and Google Scholar search engines were searched using the key terms ‘telemedicine’, ‘diabetes’, ‘COVID-19 up to 31st March 2020. In addition, existing guidelines including those by Ministry of Health and Family Welfare (MOHFW), Government of India, were accessed. Results We discuss evidence and general guidelines regarding role of telemedicine in patients with diabetes along with its utility and limitations. Conclusions Telemedicine is a useful tool for managing patients of diabetes during this lockdown period. However, there is limited data and further research is required.

Patients with diabetes who get coronavirus disease 2019 (COVID-19) are at risk of a severe disease course and mortality. Several factors especially the impaired immune response, heightened inflammatory response and hypercoagulable state contribute to the increased disease severity. However, there are many contentious issues about which the evidence is rather limited. There are some theoretical concerns about the effects of different anti-hyperglycaemic drugs. Similarly, despite the recognition of angiotensin converting enzyme 2 (ACE2) as the receptor for severe acute respiratory syndrome coronavirus 2 (SARS CoV-2), and the role of ACE2 in lung injury; there are conflicting results with the use of angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARB) in these patients. Management of patients with diabetes in times of restrictions on mobility poses some challenges and novel approaches like telemedicine can be useful. There is a need to further study the natural course of COVID-19 in patients with diabetes and to understand the individual, regional and ethnic variations in disease prevalence and course.

Background and aims High prevalence of diabetes makes it an important comorbidity in patients with COVID-19. We sought to review and analyze the data regarding the association between diabetes and COVID-19, pathophysiology of the disease in diabetes and management of patients with diabetes who develop COVID-19 infection. Methods PubMed database and Google Scholar were searched using the key terms ‘COVID-19’, ‘SARS-CoV-2’, ‘diabetes’, ‘antidiabetic therapy’ up to April 2, 2020. Full texts of the retrieved articles were accessed. Results There is evidence of increased incidence and severity of COVID-19 in patients with diabetes. COVID-19 could have effect on the pathophysiology of diabetes. Blood glucose control is important not only for patients who are infected with COVID-19, but also for those without the disease. Innovations like telemedicine are useful to treat patients with diabetes in today’s times., Highlights • High prevalence of diabetes is seen in patients with SARS-CoV-2 (COVID-19) and the presence of diabetes is a determinant of severity and mortality. • Diabetes might facilitate infection by COVID-19 due to increased viral entry into cell and impaired immune response. • Blood glucose control is important for all patients who have diabetes and COVID-19 infection. • Telemedicine can be very useful for the management of patients with diabetes in present times with limited access to healthcare facilities.

Choroidal melanoma is the second most common primary malignant melanoma of the body. The most common site for metastasis of choroidal melanoma is liver. Isolated brain metastases in choroidal melanomas is extremely rare. Enucleation is the classic treatment approach to choroidal melanomas and has been the preferred modality of treatment for large and complicated tumors, which compromise visual function and for which other therapies tend to fail. Prognosis of such cases are extremely poor. We report a case of a 47 year old male who presented to us with headache and right sided hemiparesis, and later was diagnosed as a case of choroidal melanoma with isolated brain metastasis. Keywords: Choroidal melanoma, Enucleation, Tumor, Metastasis.

Context Excess hepatic and pancreatic fat may contribute to hyperglycemia. Objective The objective of this study was to examine the effect of dapagliflozin (an SGLT2 inhibitor) on anthropometric profile, liver, and pancreatic fat in patients with type 2 diabetes mellitus (T2DM). Methods This is an observational interventional paired study design without a control group. Patients (n = 30) were given dapagliflozin 10 mg/day (on top of stable dose of metformin and/or sulfonylureas) for 120 days. Changes in anthropometry (circumferences and skinfold thickness), surrogate markers of insulin resistance, body composition, liver, and pancreatic fat (as measured by magnetic resonance imaging (MRI)-derived proton density fat fraction [FF]) were evaluated. Results After 120 days of treatment with dapagliflozin, a statistically significant reduction in weight, body mass index (BMI), body fat, circumferences, and all skinfold thickness was seen. A statistically significant reduction in blood glucose, glycated hemoglobin A1c, hepatic transaminases, fasting insulin, homeostatic model assessment of insulin resistance (HOMA-IR), and postprandial C-peptide was noted, while HOMA-β, postprandial insulin sensitivity, and fasting adiponectin were statistically significantly increased. There was no change in lean body mass. Compared to baseline there was a statistically significant decrease in mean liver FF (from 15.2% to 10.1%, P Conclusion Dapagliflozin, after 120 days of use, reduced pancreatic and liver fat and increased insulin sensitivity in Asian Indian patients with T2DM.

Aims We aimed to review insulin dosing recommendations, insulin regulation and its determinants, glycaemic response to carbohydrates, and the efficacy and safety of insulin therapy in different races/ethnicities. Methods We searched for articles in PubMed and Google Scholar databases up to 31 March 2021, with the following keywords: “ethnicity”, “diabetes”, “insulin”, “history of insulin”, “insulin therapy”, “food/rice”, “carbohydrate intake”, “insulin resistance”, “BMI”, “insulin dosing”, “insulin sensitivity”, “insulin response”, “glycaemic index”, “glycaemic response”, “efficacy and safety”, with interposition of the Boolean operator “AND”. In addition, we reviewed the reference lists of the articles found. Results The differential effect of race/ethnicity has not yet been considered in current insulin therapy guidelines. Nevertheless, body size and composition, body mass index, fat distribution, diet, storage, and energy expenditure vary significantly across populations. Further, insulin sensitivity, insulin response, and glycaemic response to carbohydrates differ by ethnicity. These disparities may lead to different insulin requirements, adversely impacting the efficacy and safety of insulin therapy among ethnic groups. Conclusions Race/ethnicity affects glucose metabolism and insulin regulation. Until now, international guidelines addressing racial/ethnic-specific clinical recommendations are limited. Comprehensive updated insulin therapy guidelines by ethnicity are urgently needed.

Introduction: Fracture of distal end radius are one of the most common skeletal injuries encountered in the orthopaedic practice. There are various modalities of treatment but plating allows secure internal fixation with resultant early return of wrist function by directly restoring the anatomy. The purpose of this study was to evaluate the clinical and functional outcome of the surgical management of intra-articular fractures of distal radius by ORIF with volar plate. Materials and Methods: It was a prospective study in which 25 patients with intra-articular distal radius fracture were managed primarily by ORIF with volar plate whose screws were multidirectional. The clinical and functional outcome was assessed using Gartland and Werley score, and Mayo Wrist score respectively.Results: The study included 25 patients, 19 males and 6 females aged from 21 to 70 years with mean of 38 years. Ulnar styloid fracture was present in 6 patients and DRUJ instability was present in 4 patients. The average duration of follow-up was 7 months ranged from 1-15 months. Using Gartland and Werley 92% had excellent to good result while 79% had excellent to good functional outcome according to Mayo score.Conclusions: Early Primary fixation of the distal radius fractures is important for good functional outcome and to avoid complication of prolonged immobilization, which facilitates early return to regular activities.

Background and aims Asian Indian patients with type 2 diabetes mellitus (T2DM) have a high cardiovascular risk even at young age. There is a need to assess this increased risk and identify atherosclerosis early so that appropriate measures for risk reduction can be taken. We aimed to study carotid-femoral pulse wave velocity (Cf-PWV), a non-invasive indicator of atherosclerosis, in patients with diabetes below 50 years of age and its correlation with markers of obesity and other cardiovascular risk factors. Methods Patients (n, 299) with T2DM below 50 years of age underwent measurement of Cf-PWV by applanation tonometry. Anthropometric parameters, blood pressure, liver span, glycosylated hemoglobin, serum lipid profile, urinary microalbumin, ankle brachial index and carotid intima media thickness were measured. Results Data show that 32.4% of patients had high Cf-PWV, with mean values higher in males than females. On stepwise multiple linear regression analysis, the significant independent determinants of PWV were age, systolic blood pressure, waist circumference, microalbumin and liver span. Conclusion About one third patients with T2DM less than 50 years of age, in north India have increased arterial stiffness which correlates with blood pressure, abdominal obesity, liver size and microalbumin, indicating increased risk for coronary artery disease.

Despite a large population and limited health infrastructure, the incidence and mortality of Coronavirus Disease 2019 (COVID-19) has been lower in South Asia than many regions. The underlying reasons and mechanisms for this relative protection are not established. However both genetic and environmental factors might play a role. Polymorphisms in ACE2 gene, ACE gene and in genes for some of the host cell proteases could affect the viral entry and replication. There is some evidence that HLA polymorphisms and several pathways involved in immune and inflammatory response could contribute to ethnic variation. Cross immunity because of past exposure to viral infections as well as malaria is likely to protect from the severe manifestations of disease. Role of BCG vaccination in trained innate immunity is recognised and could be a protective factor against COVID-19. There is limited evidence of the possibility of a less virulent viral strain circulating in South Asia. There is evidence from different parts of the world that temperature and humidity can influence viral survival as well as the host immune response. Finally implementation of early containment measures by some South Asian countries has also contributed to a less disease burden.

Background and aims Multiple issues in management of COVID have emerged, but confusion persists regarding rational interpretation. Aim of this brief review is to review these issues based on current literature. Methods This is a narrative review with Pubmed and Google Scholar search till 23 March 2020. Search terms were, COVID-19, treatment of coronavirus, COVID 19 and following terms; chloroquine, hydroxychloroquine, ibuprofen, ACE-inhibitors or angiotensin receptor blockers, cardiovascular disease, diarrhoea, liver, testis and gastrointestinal disease. Results We discuss evidence regarding role of chloroquine and hydroxychloroquine in treatment and prophylaxis, use of inhibitors of the renin angiotensin system, safety of ibuprofen, unusual clinical features like gastrointestinal symptoms and interpretation of tests for cardiac enzymes and biomarkers. Conclusions While our conclusions on management of COVID-19 patients with co-morbidities are based on current evidence, however, data is limited and there is immediate need for fast track research.

SGLT-2 inhibitors are known to increase hematocrit. We present two cases with marked asymptomatic erythrocytosis developing after taking SGLT-2 inhibitors. No other predisposing or causative factor was found and SGLT-2 inhibitor drug was the most likely cause in both cases. Both patients underwent phlebotomy and haematocrit came down after withdrawing the offending drug.

Background Dipeptidyl peptidase 4 (DPP4) inhibitors have increasingly been linked to bullous pemphigoid, but there is paucity of data from India where about 1.85 million patients have been estimated to use these drugs. Methods In 30,000 patients with T2DM seen by us in two tertiary care centres since 2015, we detected 13 cases of bullous pemphigoid linked to DPP4 inhibitors. We used WHO-UMC (World Health Organisation-Uppsala Monitoring Centre) causality assessment system for assessment. Results Lesions of bullous pemphigoid appeared at varied intervals (within 1 weeks–2 years) after start of DPP4 inhibitors. Implicated drugs were Linagliptin (n, 8), Vildagliptin (n, 4) and Sitagliptin (n, 1). Mostly, lesions were seen after 60 years age, and over trunk and extremities. Skin biopsy was compatible with bullous pemphigoid in two patients. Lesions regressed within a month of stopping DPP4 inhibitors in 9 patients while delayed regression up to 6 months in 4 patients. Overall, skin lesions remitted in all patients and did not recur. Conclusion Any new bullous lesion appearing while patient is on DPP4 inhibitors should be considered as bullous pemphigoid and should necessitate prompt withdrawal of the drug.

International audience; This article presents a new test prototype that leverages the 3D printing technique to create artificial particle assembles to provide auxiliary evidences that supports the validation procedure. The prototype test first extracts particle shape features from micro-CT images of a real sand grain and replicates the geometrical features of sand grain using a 3D printer. The quantitative measurements of the particle shape descriptors reveal that the synthetic particles inherit some attributes such as aspect ratio and sparseness of the real materials while exhibiting marked differences for sphericity and convexity. While it is not sufficient to consider the printed particle assembles a replica of the real sand, the repeatable manufacture process provides convention tools to generate additional data that supports the validation procedure for particulate simulations. Oedometric compression tests are conducted on a specimen composed of the printed particles of identical size and shape to create benchmark cases for calibrating and validating discrete element models. Results from digital image correlation on the synthetic sand assemblies reveal that the fracture and fragmentation of the synthetic particles are minor, which in return makes particle position tracking possible. As our prototype test and research data are designed to be open source, the dataset and the prototype work will open doors for modelers to design further controlled experiments using synthetic granular materials such that the individual influence of each morphological feature of granular assemblies (e.g., shape and size distribution, void ratio, fabric orientation) can be individually tested without being simultaneously affected by other variables.

Background and aims Mucormycosis is an invasive fungal infection and carries a significant morbidity and mortality. A number of cases of mucormycosis have been reported in association with COVID-19. In this study, a consortium of clinicians from various parts of India studied clinical profile of COVID-19 associated mucormycosis (CAM) and this analysis is presented here. Methods Investigators from multiple sites in India were involved in this study. Clinical details included the treatment and severity of COVID-19, associated morbidities, as well as the diagnosis, treatment and prognosis of mucormycosis. These data were collected using google spreadsheet at one centre. Descriptive analysis was done. Results There were 115 patients with CAM. Importantly, all patients had received corticosteroids. Diabetes was present in 85.2% of patients and 13.9% of patients had newly detected diabetes. The most common site of involvement was rhino-orbital. Mortality occurred in 25 (21.7%) patients. On logistic regression analysis, CT scan-based score for severity of lung involvement was associated with mortality. Conclusion Universal administration of corticosteroids in our patients is notable. A large majority of patients had diabetes, while mortality was seen in ∼1/5th of patients, lower as compared to recently published data.