Annals of the National Academy of Medical Sciences (India)
Permanent URI for this collection
Editor: Dr. Sanjeev Misra
ISSN: 2454-5635
Frequency: Quarterly
Language: English
Open Access Peer-reviewed journal
Web site: https://annals-nams.in
Browse
Recent Submissions
Item A comparative study of neutrophil/lymphocyte ratio (NLR) and platelet/lymphocyte ratio (PLR) in bipolar mania and schizophrenia(National Academy of Medical Sciences, 2024-01) Goyal, MK; Yadav, KS; Solanki, RKObjectives: The role of immunological disturbance in bipolar disorder (BD) and schizophrenia has been highlighted by some studies. There are few studies available that compared the inflammatory markers between schizophrenia and BD, but only one study demonstrated the difference in terms of neutrophil/lymphocyte ratio (NLR) and Platelet/lymphocyte ratio (PLR) between them. So this study was conducted to compare the NLR and PLR values among schizophrenia, bipolar mania, and healthy controls in order to find out a potential biomarker for these disorders. Material and Methods: Eighty consecutive patients suffering from bipolar mania, 80 suffering from schizophrenia, and 80 healthy controls were recruited in the psychiatric center situated at a tertiary care hospital. Blood samples of all groups were transferred to the laboratory for complete blood count analysis. Thereafter, all the groups were compared by applying proper statistics. Results: Significant higher level of neutrophil count and NLR value was seen in both bipolar mania and schizophrenia groups compared to healthy controls. There was no difference observed between schizophrenia and the bipolar mania group regarding NLR, PLR, neutrophils, lymphocytes, and platelets values. Conclusion: NLR has appeared as a potential marker in our study, and it reflects a state of low-grade inflammation in both schizophrenia and bipolar mania. BD and schizophrenia have been considered as part of one continuum, which is also supported by the findings of our study. These markers can help in the prognosis and treatment of at least a subsection of patients and also are inexpensive and easy to assess.Item Risk stratification in multiple myeloma – A review and update(National Academy of Medical Sciences, 2024-04) Das, N; Gupta, RMultiple myeloma (MM) is a hematological malignancy of plasma cell origin with a prevalence rate of 1% and 10% of all cancers and hematopoietic malignancies, respectively. Though the median survival time has improved dramatically in the patients diagnosed with MM with the administration of novel therapeutic agents, the disease, by and large, remains incurable with frequent progression and relapses. In the recent past, an increased understanding of MM pathogenesis has opened facets for improved diagnosis, prognosis, and response assessment in patients diagnosed with MM. This review focuses on the various laboratory and clinical features used to stratify the MM patients into high vs. low-risk groups. Furthermore, it also highlights the role of artificial intelligence-based innovative research tools for risk stratification and prognostication in MM patients.Item Diminished LC3 expression with unchanged Beclin 1 levels in right atrial appendage tissue of diabetic patients undergoing coronary artery bypass graf(National Academy of Medical Sciences, 2024-01) Rajendran, RS; Jayakumari, NR; Pillai, VV; Karunakaran, J; Gopala, SType 2 diabetes potentiates the risk of heart failure. A vital physiologic process, autophagy, may be impaired in the diabetic heart. The purpose of the present work was to explore the autophagic status in the human diabetic heart. Techniques like immunohistochemistry and western blotting were employed to examine the expression of some of the important proteins involved in autophagic machinery. Our brief study reports, for the first time, evidence of decreased cardiac autophagic levels in diabetic patients.Item Recovery of memory decline during aging - role of epigenetics(National Academy of Medical Sciences, 2024-04) Mishra, E; Thakur, MKAging is a natural phenomenon associated with the accumulation of multiple alterations, including memory loss. Such deterioration of memory is based on the susceptibility of specific brain regions and the disorders that coincide with aging in those areas. Previous findings suggest that the optimal expression of synaptic plasticity-related genes is essential for memory formation and consolidation. Epigenetic modifications are one of the most crucial factors that cause memory deterioration by inducing the differential expression of synaptic plasticity-related genes. Understanding the fundamental cause of cognitive alterations that arise with aging is very essential for the development of therapeutic and/or preventive approaches. Several strategies have been employed to restore or reverse the memory decline caused by age-associated epigenetic alterations. The present article emphasizes the role of epigenetic alterations caused by histone modifications, DNA methylation, and non-coding ribonucleic acids (RNAs) on memory during aging. Also, we highlight the mechanistic switches of brain aging, including physical exercise, nutraceuticals, epigenetic modifiers, modulators of non-coding RNAs, and associated targets for therapeutic interventions. The emerging field of neuropharmacology and pharmacoepigenomics provides evidence that small drug molecules are currently employed to treat memory loss associated with aging, particularly by targeting epigenetic systems like DNA methylation, chromatin remodeling, histone modifications, and small non-coding RNAs. Therefore, targeting epigenetic modifications could be a potential therapeutic approach for the improvement of synaptic plasticity, neuronal activities, memory, and other brain functions during aging.Item Rifampicin-induced thrombocytopenia in a patient with abdominal tuberculosis(National Academy of Medical Sciences, 2024-01) Boddu, R; Sharma, A; Mishra, K; Kumar, SMost anti-tubercular drugs are relatively safe, but adverse reactions are not uncommon. Rifampicin is one of the most effective and widely used antituberculosis drugs. Adverse effects due to rifampicin are not uncommon and the patients usually have skin rash, gastrointestinal disturbances, and hepatotoxicity. Rarely, the patients may also have allergic and autoimmune manifestations, which may include life-threatening thrombocytopenia. A high index of suspicion and careful evaluation for temporal association with the suspected drug are required to diagnose drug-induced immune thrombocytopenia. We present a case of rifampicin-induced thrombocytopenia; though relatively rare, it needs attention.Item A review of the adverse impacts of allergic rhinitis on health-related quality of life and its evaluation(National Academy of Medical Sciences, 2024-04) Srivastava, P; Patil, SAIt has been proven that successfully treating allergic rhinitis (AR) with non-sedating antihistamines, intranasal corticosteroids, and other widely used, approved treatments results in improvements in health-related quality of-life questionnaires by incorporating health-related quality of life measures in clinical trials. Analyze therapeutic modalities that provide reliable and practical solutions to minimize the effects of this illness. The effects of AR on people’s health and quality of life should be examined by doctors. Better patient-provider communication and a deeper comprehension of AR may help with the treatment of this illness.Item A narrative review on rebound acid hypersecretion due to long-term use of proton pump inhibitors(National Academy of Medical Sciences, 2024-04) Balivada, V; Koraykar, RMObjectives: Proton pump inhibitors (PPIs) are the most commonly used drugs to reduce hyperacidity. The usage of PPIs reduces the secretion of gastric juice; their prolonged usage results in gastric acid suppression with hypergastrinemia while their stoppage results in hypersecretion of gastric juice. This kind of paradoxical reaction is seen in the rebound effect of drugs. Dr. Samuel Hahnemann gave us the vital principles of homeopathy, the law of similitude, i.e., “similia similibus curentur” derived from the “Nature’s Law of Cure”. This also tells us that the primary action of medicine stimulates the dynamic expression of an organism (vital force), which results in the counteraction called secondary action by the organism. Material and Methods: Review of literature on the effects of long-term use of PPIs and rebound hypersecretion of gastric juice due to PPIs. Results: For this review article, 16 most relevant articles are selected from the search results. Thirteen systematic reviews, two randomized control trials, and one pilot study are included. Rebound acid hypersecretion (RAHS) occurs after prolonged treatment with histamine-2 blockers and PPIs, causing gastric hypoacidity and hypergastrinemia. Longer PPI durations can result in prolonged hypersecretion, with moderate hypergastrinemia and increased enterochromaffin-like (ECL) cell hyperplasia. Deprescribing PPIs is crucial to reduce RAHS and safety concerns. Long-term usage can lead to nutritional deficiencies, respiratory infections, and bone fractures. Conclusion: Homeopathic remedies have shown significant results in treating symptoms caused due to gastritis, ulcers, gastroesophageal reflux disease, etc., and further research is needed to reduce RAHS caused due to the long-term use of PPIs.Item Loss of lateral femoral condyle following sepsis of knee region in infancy: The hypothesis of vascular pathogenesis and clinical course(National Academy of Medical Sciences, 2024-07) Agarwal, A; Jethwa, RComplete loss of lateral femoral condyle of the femur following sepsis of the knee region in infancy is a well-recognized entity. The etiopathogenesis of the sequelae is poorly understood with synovial plicae and post-septic growth disturbance postulated as possible causes. Two illustrative cases are presented to elucidate the clinical effects of condylar loss in the pediatric age group.There is a typical pattern of unicondylar damage, loss of adjacent metaphysis, and metaphyseal spur in involved cases. Abnormal loading of the knee, ligament laxity, and the presence of a physeal bar contribute additionally to deformity. The deformity progression can be as rapid as 2.8 degrees per month. The lesion is most often treated by balancing the knee mechanics using osteotomies and growth modulations. The lesion progresses downhill due to the absence of lateral support of the knee joint configuration. The anatomical region supplied by the superior lateral genicular vessels closely matches with the lateral unicondylar femoral loss seen post-sepsis. A vascular etiology is therefore hypothesized for the lesion.Item Spectrum of bacterial isolates and their antibiogram in intensive care unit (ICU) of tertiary care hospital as a part of hospital acquired infection (HAI) surveillance(National Academy of Medical Sciences, 2024-07) Deb, J; Debnath, S; Bhattacharya, S; Majumdar, TObjectives: The introduction of the study discusses the prevalence of Urinary Tract Infections (UTIs) as a common hospital-acquired infection worldwide. The specific goals of the study were to isolate and identify the organisms causing UTIs, and determine their antimicrobial sensitivity patterns. Material and Methods: A total of 150 consecutive urine samples were collected over a 24 month period from selected surveillance units Medical-Surgical ICU (MICU) Respiratory ICU (RICU) Pediatric ICU (PICU). Microbiological culture, subsequent bacterial identification and antimicrobial susceptibility test were performed for the positive samples. The prevalence of the causative agents was analyzed according to the patient’s gender and age group. Results: A total of 45 uropathogens were isolated, with Enterococcus spp. being the most common at 33.3%. The study found that Nitrofurantoin antibiotic had the highest sensitivity at 77% against Enterococcus spp. The study also found that nosocomial infections lengthened hospital and intensive care unit stays, and during the surveillance period eight patients expired, who were infected by Enterococcus spp., Klebsiella pneumoniae, Enterobacter spp. and Klebsiella spp. Conclusion: The conclusion section of the study highlights that the study documented the pathogenic effect of Enterococcus spp., which was responsible for the majority of infections. This study may be useful for future studies to assess the genetic profile of the MDR gene of isolated microorganisms and to early assess the methods for detecting pathogenic organisms in clinical samples in order to save lives in critical care units. The study also suggests that Nitrofurantoin antibiotic was found to be the most effective against urinary tract isolates of Enterococcus spp.Item Six-minute walk test among silicosis patients: Its correlation with abnormal radiographic findings on chest radiograph and high resolution computed tomography scan(National Academy of Medical Sciences, 2024-07) Jalutharia, J; Dixit, R; Kuldeep, R; Goyal, M; Choudhary, M; Srivastava, KObjectives: Silicosis is one of the oldest chronic lung diseases that leads to relentless fibrotic changes in the lungs with a resultant fall in lung functions. is study was conducted to assess exercise capacity utilizing a six-minute walk test (6-MWT) among patients detected to have “simple” and “complicated” forms of silicosis. A further correlation between 6-MWT parameters and abnormal chest imaging findings was also done. Material and Methods: Silicosis diagnosis among study subjects was based on the history of exposure to occupational silica dust along with suggestive radiological findings of pneumoconiosis assessed by the trained experts. Study subjects performed the 6-MWT as per standard protocol. Chest radiological and “high resolution computed tomographic” (HRCT) abnormalities were also analyzed in each subject and compared with their 6-MWT components (distance walked in meters and oxygen desaturation occurrence, if any). Results: One hundred twelve study subjects (males 106 and females 6; mean age 44.05+10.84 years) constituted the final study population. e sixminute walk distance (6-MWD), fall in SpO2 and BORG dyspnea scale in patients with grade “0” on chest X-ray was 362.79 ± 34.2 meter, 1.28 ± 0.91% and 0.96 ± 0.59, respectively and these parameters gradually converted with increasing International Labour Organization silicosis grading with 94.21 ± 29.4 meter, 7.11 ± 1.61% and 4.50 ± 0.93, respectively in grade “C.” A gradual change in 6-MWT parameters was also evident when compared with HRCT scan grading abnormalities. Conclusion: Results of this study shows abnormally reduced lung function parameters among subjects with silicosis and it also correlates with degree of the profusion of nodules seen radiologically both on chest radiograph and HRCT.Item Influence of COVID infection or vaccination on pregnancy outcome(National Academy of Medical Sciences, 2024-07) Satheesh, S; Tadikonda, S; Jitta, S; Hasan, AObjectives: The study aimed to assess the effect of Covid infection or Vaccination on pregnancy outcomes. Material and Methods: Infection and vaccination status of 372 women were collected during the pandemic period (March 2020 to March 2022) from medical records and personal interviews of pregnant women visiting two hospitals for antenatal care and through a survey form circulated online. Seventy-eight women were still on follow-up during the study. The women were categorized into (i) Infected during gestation, (ii) Vaccinated before pregnancy, (iii) Vaccinated during pregnancy, (iv) Vaccinated after delivery (v) unvaccinated. Individuals in (iv) and (v) categories were taken as controls. Results: Thirty-six women were infected during gestation, 156 were vaccinated before/during pregnancy, and 180 were kept as controls The result showed that 35 individuals from the sample size had adverse pregnancy outcomes such as Spontaneous abortions, MTPs (Carried out after an ultrasound detected abnormality), and Intrauterine deaths, 4 of them were infected and 23 were vaccinated before/ during pregnancy, and 8 were the controls, indicating that 77% of individuals with adverse pregnancy outcomes were exposed to either virus/vaccination. Eighty-nine women had mild complications during pregnancy, such as Oligo/Polyhydramnios, Abnormal USG, and biochemical markers. 56.1% of these individuals were exposed to the virus or vaccination, slightly higher than the control group. Conclusion: In this preliminary follow-up study, an association was seen between SARS-CoV-2 infection, COVID-19 vaccination, and adverse pregnancy outcomes.Item Serum phosphorus levels as a predictor and severity marker for mechanical ventilation in adults versus elderly patients – A cross-sectional study(National Academy of Medical Sciences, 2024-07) Ambali, AP; Tomar, P; Shivanand, LKObjectives: Mechanical ventilation (MV) is a supportive therapy for patients with acute respiratory failure. Studies have shown direct relationship between serum phosphorus on admission and risk of respiratory failure requiring MV. This study aims to determine admission serum phosphorus level’s ability to predict severity in 64 mechanically ventilated patients among two groups: Group A was designated to adults (<60 years of age) and Group B to elderly (60 years or older) admitted to the critical care unit (CCU). Study Design: It is a cross-sectional study. Material and Methods: Data were collected from 64 adults admitted to CCU. The Sequential Organ Failure Assessment (SOFA) score and serum Phosphorus level on admission were assessed. Patients with Diabetic Ketoacidosis, Head Trauma, Renal Failure, Hyper or Hypoparathyroidism, Leukaemia, and Lymphoma were excluded. Results: The study had 32 subjects in each group. The commonest indication for mechanical ventilation was Poisoning (31.25%) in Group A and Cerebrovascular Accident (34.37%) in Group B. The common complication among the study group was ventilator- associated pneumonia (14.06%). Out of 64 patients requiring mechanical ventilation, nine patients had hypophosphatemia, and eighteen had hyperphosphatemia. In the case of hypophosphatemia, 100% and in hyperphosphatemia, 55.5% mortality was observed. Conclusion: Altered serum phosphorus levels on admission can be a potential indicator for requiring MV and mortality. Both hypophosphatemia and hyperphosphatemia are potential risk factors for the development of respiratory failure. Also, age-related variation in phosphorus levels has not shown any association with the outcome.Item A rare incidence of cerebral venous thrombosis in a case of immune thrombocytopenia on eltrombopag(National Academy of Medical Sciences, 2024-07) Mishra, K; Barki, S; Sreen, A; Saravagi, G; Kumar, SImmune Thrombocytopenia (ITP) typically presents with mucocutaneous bleeding. Splenectomy, rituximab, and thrombopoietin receptor agonists (TPO-RAs) are the recommended second-line therapy. Eltrombopag is one of the TPO-RAs used for the treatment of steroid-refractory ITP, with a response rate of 70–80%. Though rare, yet various cases of venous thromboembolism have been reported from clinical trials as well as real-world studies. We present a case of ITP that was refractory to corticosteroid and second-line drugs; however, it responded to eltrombopag. While having a complete response on eltrombopag, the patient developed Cerebral Venous Thrombosis.Item Perspectives of Indian medical students regarding the competency based medical education curriculum – A qualitative, manual, theoretical thematic content analysis(National Academy of Medical Sciences, 2024-07) Shanmugam, J; Ramanathan, R; Kumar, M; Sridhar, MG; Palanisami, KT; Narayanan, SObjective: A competency-based undergraduate curriculum for the Indian Medical Graduates has been introduced since August 2019. The objective of this study was to capture the perspectives of students regarding the competency-based medical education curriculum. Material and Methods: We present the qualitative findings from a multicentric cross-sectional study conducted among first-year MBBS students of selected medical colleges in India (2019–2020 batch) enrolled using a multistage random sampling method between February and March 2020. Qualitative data were analyzed using manual, theoretical thematic content analysis following the steps endorsed in Braun and Clarke’s six-phase framework. Results: Of the 336 medical students, 175 (52.1%) were from the government and 154 (45.8%) were from private medical colleges. The initiatives that were perceived to be most useful by students were sports, including extracurricular activities; attitude, ethics and communication (AETCOM) modules; yoga sessions;field visits; and skills modules (especially basic life support training). The duration of the foundation course, documentation of early clinical exposure, self-directed learning in the form of logbooks, records and related assignments for each subject, and pattern of assessment methods were initiatives that required modifications from student's perspective. Also, the suggestions provided by students to improve the curriculum has been summarized in this article that included changes in pattern of question papers, introducing skill certification, capturing subject based – student centered reflections, making available a mental health counselor, introducing literary clubs, and inter medical college visits. Conclusion: The introduction of competency based medical education for undergraduate curriculum is a step in the right direction. But the need of the hour is to continuously adapt – based on the experiences of teachers, administrators, other stakeholders and students in particular.Item Vitamin A, E, and C levels in maternal blood of patients with idiopathic preterm premature rupture of membranes, spontaneous preterm birth, and term birth(National Academy of Medical Sciences, 2024-07) Mehndiratta, M; Suneja, A; Almeida, EA; Garg, S; Kar, R; Gupta, B; Kumari, R; Puri, DObjectives: To compare vitamin A, E, and C levels in cases with idiopathic preterm premature rupture of membranes (pPROM), idiopathic spontaneous preterm birth with intact membrane (sPTB), and term birth (TB). Material and Methods: There were three groups in this study: pPROM, sPTB, and TB. The sample size was 60 patients in each group (n = 60, Total = 180). Serum vitamin A and E levels and leucocyte vitamin C levels were measured using commercially available research kits. Results: The mean (SD) vitamin A levels were 49.56 (18.66) µg/dL in the pPROM group, 48.67 (10.28) µg/dL in the sPTB group, and 52.69 (24.39) µg/dL in the TB group. The mean (SD) vitamin E levels were 19.17 (9.23) µg/dL in the pPROM group, 16.94 (10.17) µg/dL in the sPTB group, and 17.47 (11.19) µg/dL in the TB group. The mean (SD) vitamin C levels were 47.89 (9.53) µM in the pPROM group, 45.78 (7.92) µM in the sPTB group, and 42.35 (6.14) µM in the TB group. Vitamin C levels were significantly higher in mothers who developed pPROM (p<0.05) when compared with TB and tended toward significance in mothers who developed sPTB compared with TB. Conclusion: Vitamin A and E levels were comparable in all three groups. Higher leucocyte vitamin C levels, observed in patients with pPROM (vsTB) and sPTB (vsTB), were not able to protect against pPROM and sPTB. Thus, supplementation of these vitamins during pregnancy is questionable and needs further exploration.Item Association of KCNJ11 gene (rs5219) polymorphism with HOMA-IR and HOMA B values in type 2 diabetes mellitus in India: A case-control study(National Academy of Medical Sciences, 2024-07) Ramteke, A; Suneja, S; Muntakhab, M; Gangopadhyay, S; Kaur, CObjectives: Type 2 diabetes mellitus (T2DM) is a complex illness that results from either insulin resistance or insufficient insulin, which raises blood sugar levels. Numerous genes interact to influence the secretion of insulin. A gene of great interest is KCNJ11 of subfamily-J, member 11, which functions as an inwardly rectifying ATP-sensitive potassium (KATP) channel in pancreatic beta cells and is involved in glucose-stimulated insulin release. Material and Methods: The present case-control study attempts to delineate the genetic impact of KCNJ11 (rs5219) gene polymorphism on the risk of T2DM in the Indian population. It involves 55 patients with type 2 diabetes (fasting plasma glucose of >126 mg/dl, 2-h glucose of >200 mg/dl, or HbA1c level of >6.4%) and 55 healthy controls (fasting plasma glucose of <100 mg/dl, 2-h glucose of <140 mg/dl, or HbA1c level of <6.4%). polymerase chain reaction (PCR)-restriction fragment length polymorphism (RFLP) was used to study KCNJ11 polymorphism through a standard protocol. Enzyme Linked Immunosorbent Assay (ELISA) was used to estimate serum Insulin levels. HOMA-IR & HOMA-? values were calculated. Statistical analysis was done using t-test, Chi-Square test, and One-way analysis of variance (ANOVA) test. Results: Serum insulin levels and HOMA-IR values were significantly decreased in cases than in the control group. Logistic regression analysis showed that the frequency of KK genotype in T2DM individuals (21.8%) was higher than the control group (9%) (p = 0.01). Frequency of K allele (38%) in patients was higher than the control group (18%) (p = 0.001). The K allele risk in diabetic patients was 9.9 times higher as compared to controls (p = 0.001, OR 9.9, 95%Cl 0.036–0.36). Homeostatic model assessment ? (HOMA-?) values of KK genotype (59.9±27.8315) were lower than that of EK (76.8±33.23) and EE (127.9±44.59) genotypes (p < 0.001). Conclusion: The presence of KCNJ11 (rs 5219) gene polymorphism shows a noteworthy correlation with the likelihood of developing T2DM among the North Indian population. K allele is more likely to be present in individuals with T2DM than the control group. Moreover, HOMA-? values of those with the KK genotype were found to be lower than the individuals having EK and EE genotypes.Item Atypical progress of tuberculosis in the peripartum period: Report of a paradoxical reaction(National Academy of Medical Sciences, 2024-07) Sharma, J; Dorairajan, GCentral nervous system involvement is noted in approximately 1% of all Tuberculosis (TB) cases. Worsening of pre-existing tubercular lesions following antitubercular treatment in the absence of disease relapse or any other diagnosis is called a paradoxical reaction. We detail an atypical evolution of TB in a pregnant woman. We report the case of a woman admitted with respiratory symptoms at 35 weeks of Pregnancy. She had a spontaneous onset of labor within 48 hours and delivered a 1.6 kg live baby. Investigations confirmed pulmonary TB. She was started on antituberculosis treatment. Post-partum, she developed persistent headaches, and the imaging confirmed tuberculoma in the left inferior frontal gyrus with leptomeningeal enhancement. She was started on steroids. She was readmitted after two weeks due to a new onset holocranial headache, and MRI detected a new large tuberculoma in the temporal region hence, a diagnosis of Pleuropulmonary with Extrapulmonary tuberculosis with a Paradoxical reaction was made. Anti-edema measures were added, and the patient was managed in hospital for another 2 weeks. The case details and the possibility of flare due to puerperium and steroids are discussed. In pregnant women with active TB disease, complications of perinatal death, preterm birth, acute fetal distress, and low birth weight are increased. The risks of untreated active disease in a pregnant woman are higher than the risks of its treatment. A high index of suspicion, avoiding overcrowding, proper nutrition, timely and appropriate initiation of treatment may have a favorable pregnancy outcome.Item An insight into the heatstroke in Northern India: Clinico-pathological observation and outcomes from a tertiary care center(National Academy of Medical Sciences, 2024-07) Pursnani, N; Yadav, SK; Doneria, JK; Agrawal, P; Gautam, AObjectives: To observe the clinical presentation, pathological changes, and outcomes of heatstroke at a tertiary care center. Material and Methods: Patients presented with an axillary temperature above 104°F to the casualty during summers in the months of April and May 2022 were screened. After excluding the other causes of fever and based on history, patients were diagnosed as suffering from heatstroke. After taking valid consent, treatment was initiated, and all observations were taken. Clinical presentation, demographic data, vitals, and investigations (hemogram, renal function, liver function, CPK, IL6, CRP, and random glucose levels) were recorded, diagnosed, and enrolled for observation. Chi-Square test for 2 x 2 contingency table used to identify the association between CPK and muscle cramps. The T-test for 2 Independent Means and the Pearson Correlation Coefficient test were used for analyzing other data. Results: For the study, 112 patients were enrolled and classified as per severity: 80 were pre heatstroke, 22 were mild heatstroke, and 10 were severe heatstroke. Age above 50 years is associated with severe forms of disease and poor outcomes. Out of 112, 28 (25%) participants were 50 years or above age. Nine (32.1%) out of these 28 developed pre-heatstroke, and 19 (67.8%) developed mild to severe heatstroke. Creatinine kinase was raised in 17 out of 112 (15.1%) participants, but the proportion of participants having raised CPK does not differ by the presence of myalgia. IL6 was also found to be elevated and related directly to the severity of the disease in this study. Conclusion: Heatstroke is a common disease that occurs due to working on farms during the summer. Old age is more prone to severe disease and poor outcomes. Raised IL6 also correlates directly with disease severityItem Comparison of seven commercial RT-PCR kits with the NIV kit for the diagnosis of Covid-19(National Academy of Medical Sciences, 2024-01) Chhabra, M; Nirmal, K; Chauhan, A; Athotra, A; Kansra, S; Shulania, A; Achra, A; Duggal, NObjectives: Coronavirus disease 2019 (COVID-19) caused by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) spread across the globe in an unprecedented manner and was declared a pandemic on March 11, 2020 by the World Health Organization (WHO). This study was carried out with the aim to compare the sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and agreement of the eight different RT-PCR kits for the diagnosis of COVID-19. Material and Methods: This observational cross-sectional study was carried out in the Department of Microbiology of a tertiary care hospital in Central Delhi from July to October 2021. A total of 45 nasopharyngeal and/or oropharyngeal swabs in Viral Transport Medium (VTM) from suspected COVID-19 patients were received in the laboratory for RT-PCR. These samples were tested by eight different Indian Council of Medical Research (ICMR)-approved RT-PCR kits with different gene targets. The comparison was made with the National Institute of Virology (NIV), the Pune COVID-19 RT-PCR kit. Statistical analysis: sensitivity, specificity, PPV, and NPV were calculated for each kit and compared using the McNemar test. Agreement of different kits was evaluated using Kappa analysis. Results: The results of the 45 samples of suspected COVID-19 cases were recorded as per the cycle threshold (Ct) provided in the kit insert. Of these, 15 samples detected both E and RdRp genes and 30 were negative for both the genes of SARS CoV-2 by NIV, the Pune COVID-19 RT-PCR kit. All kits showed 100% sensitivity and had 100% NPV when compared with the NIV kit. However, specificity, PPV, and agreement were variable as compared to the NIV kit. Conclusion: The reporting should be carried out as per the manufacturer’s instructions. However, positive results with Ct values ? 36 showed variable results with different RT PCR kits and hence should be interpreted with caution.Item Comparison of hematologic parameters as predictors of severity in COVID-19: A single-center cross-sectional study(National Academy of Medical Sciences, 2024-04) Gogoi, P; Diwaker, P; Kapoor, R; Narang, S; Goswami, SJCOVID-19 disease was a global pandemic that marred humanity globally from 2019 end till early 2023. The diseases caused by the novel SARS cov2 virus had a wide array of presentations, from asymptomatic to mild illness to severe acute respiratory illness, with patients presenting with ‘happy hypoxia and sudden deterioration of clinical condition to multiorgan involvement and proven to be fatal in many cases. There was an effort to identify a point-of-care test to screen patients so as to predict the disease course; therefore, this study was designed to compare hematologic parameters to predict the severity of the disease. This study showed that TLC,dNLR, and NLR can be effectively used in diagnosing severe COVID-19.