COVID-19 has caused devastating effects worldwide ever since its origin in December 2019. IL-6 is one of the chief markers used in the management of COVID-19. We conducted a longitudinal study to investigate the role of IL-6 in diagnosis, treatment, and prognosis of COVID-19-related cytokine storm. Patients with COVID-19 who were admitted at AIIMS Rishikesh from March to December 2020 were included in the study. Patients with no baseline IL-6 value at admission and for whom clinical data were not available were excluded. Clinical and laboratory data of these patients were collected from the e-hospital portal and entered in an excel sheet. Correlation was seen with other inflammatory markers and outcomes were assessed using MS Excel 2010 and SPSS software. A total of 131 patients were included in the study. Of these, 74.8% were males, with mean age 55.03 ± 13.57 years, and mean duration from symptom onset being 6.69 ± 6.3 days. A total of 82.4% had WHO severe category COVID-19, with 46.56% having severe hypoxia at presentation and 61.8% of them having some comorbidity. Spearman rank correlation coefficient of IL-6 with D-dimer was 0.203, with LDH was −0.005, with ferritin was 0.3, and with uric acid was 0.123. A total of 11 patients received Tocilizumab at a mean duration from symptom onset of 18.09 days, and 100% mortality was observed. Deaths were reported more in the group with IL-6 ≥ 40 pg/mL (57.1% vs. 40.2%, p = 0.06). ICU admissions and ventilator requirement were higher in the IL-6 ≥ 40 pg/mL group (95.9% vs. 91.4%, p = 0.32 and 55.1% vs. 37.8%, p = 0.05). The study showed that IL-6 can be used as a possible “thrombotic cytokine marker”. Higher values of IL-6 (≥40 pg/mL) are associated with more deaths, ICU admissions, and ventilator requirement.

Antiphospholipid syndrome (APS) is an autoimmune disease present most commonly in young women, characterized by the presence of antibodies against various phospholipids and culminating in alteration of the flow of blood, leading to arterial and venous thrombosis. Although it can present with a wide range of manifestations, digital gangrene is one of the important ones. We present a case of a young female with antiphospholipid syndrome who presented with acute onset bilateral upper limb symmetrical digital gangrene with prior history of multiple fetal losses. Acute onset, symmetrical gangrene, limited to the bilateral upper limbs without venous system involvement, that too in association with systemic lupus erythematosus (SLE) which does not usually manifest as such make this case a unique and interesting one.

INTRODUCTION: Gastrointestinal neuropathies are frequently found in diabetic patients. AIM: The aim of this study was to find out the safety, adverse reactions, and long-term effectiveness of Pistacia lentiscus plant extract (mastic gum) in diabetic gastroparesis (DG) with respect to sustainable improvement in gastroparesis symptoms (Gastrointestinal Cardinal Symptom Index [GCSI] score) by observational follow-up study of a single-centric double-blind noninferiority randomized control trial. MATERIALS AND METHODS: Thirty-eight individuals were recruited and equally randomized in two study groups based on GCSI score and TC ⁹⁹ radionuclide gastric emptying scintigraphy (GES), i.e. the mastic gum group and the levosulpiride group. After 24 weeks, the GCSI score was recalculated in both the groups, and patients were evaluated for the safety, adverse reactions, and long-term effectiveness of mastic gum and the standard drug levosulpiride. RESULTS: In the extended study, mean GCSI score changes at 24 weeks were statistically significant ( P < 0.001) ( t -test) between the two groups. In the mastic gum arm, the change in mean GCSI score at 24 weeks was statistically nonsignificant mean ± (standard deviation [SD]) 16.7± (3.81) compared to the GCSI score at 2-month postintervention mean (SD) 16.35± (2.27) (intragroup P = 0.89) (repeated measures ANOVA). It strongly indicates that mastic gum provided a sustainable improvement in DG symptoms in comparison to levosulpiride, with excellent subjective well-being postintervention, without any obvious significant adverse effects. CONCLUSION: Six-month (24-week) interim analysis of patients suggests that mastic gum gives a sustainable improvement in DG symptoms without any obvious adverse effects as compared to levosulpiride.

Background: Limb loss to amputation is a major problem, especially in developing countries where the majority of the cases are preventable. It is a burden, not just for the patient but also for their caregivers. Today, when amputation is necessary, surgery is undertaken with consideration for the functional aspects of the residual limb. The purpose of this study was to describe the etiology and characteristics of major limb amputees at a tertiary care center in North India.Methods: This prospective observational study was conducted by the Government Medical College Jammu, for 2 years. Eighty-one patients underwent major limb amputations in our hospital during the study. In this study, we studied several variables including age, sex, side of the limb, level of the amputation, and etiology.Results: In this study, dysvascular disease was the major reason of amputation, diabetes mellitus being the most common cause (39.5%), followed by trauma, with a male preponderance, with peaking at the age of 51–70 years. Lower limb is the most common with the predominance of transtibial amputation. Younger individuals who underwent amputation were mostly due to the trauma. The most common postoperative complication was surgical site infection (21%) and the most common organism cultured from the wound wasPseudomonas(50%). The most common additional procedure done was wound debridement. The mortality rate was 10% and the mean duration of hospital stay was 23 days.Conclusion: In contrast to declining rates of trauma-related and cancer-related amputations, we found evidence of a significant increase in the incidence of amputations due to diabetic foot syndrome. Overall, the risk of amputations increased with age. This was true for all etiologies and for both sexes. Males with an average age of 50 years are generally at higher risk for limb loss than women.

Introduction: One of the competencies expected of all doctors posted in coronavirus disease 2019 (COVID-19) wards, is ECG rhythm identification, interpretation, and intervention for immediate management of patients. This study was undertaken to evaluate the effectiveness of the ECG training module as a component of preparedness training to combat COVID-19. Methodology: This was a cross-sectional study conducted during training on ECG rhythm identification, interpretation, its management in COVID-19 patients. Study participants included faculty, senior residents, junior residents, and interns of medical, surgical, and paraclinical disciplines. The training session included one hour of didactic lecture and one and half hours of interactive session during which case scenarios were discussed. An objective assessment was conducted through pre-test and post-test. Mean of pre and post-test scores were compared using paired t-test for evaluating statistical significance. Feedback was also taken from participants. Results: Out of the 800 participants who gave consent, only 682 who completed both pre and post-test were included in the final analysis. Mean pre-test and post-test scores were 9.29/15 (61.9%) and 11.63/15 (77.5%), respectively, with a mean improvement of +2.34/15 (+15.6%). Of the participants, 38.6% obtained low scores in pre-test and 82% of respondents agreed that knowledge and skills gained from training would be useful in providing patient care. Conclusion: Low baseline knowledge on ECG highlights the need for re-training doctors posted in COVID-19 care on cardiac rhythm identification and interpretation. Interactive training is effective in improving ECG interpretative skills among doctors across disciplines and is the appropriate method to retrain/reskill, especially for large-scale capacity building.

Neuromyelitis optica (NMO) is a rare central nervous system demyelination syndrome predominantly targeting optic nerves and the spinal cord. Here we present a middle-aged female presenting with new onset quadriparesis and a history of persistent splenomegaly and pancytopenia, eventually being diagnosed as NMO along with autoimmune cirrhosis. The association of NMO spectrum disorders (NMOSD) with chronic liver disease has not been previously described in the literature. The purpose of this case report is to bring forward an unusual presentation and to ascertain whether it could be part of a heterogenous spectrum of an autoimmune disorder, or merely a co-incidence.