Introduction: Patients with diabetes mellitus commonly develop chronic vascular complications including diabetic nephropathy (DN). Chronic inflammation plays an important role in pathogenesis of diabetes and its complications. Neutrophil-Lymphocyte Ratio (NLR) is a novel potential marker for determining inflammation. Objective: To study NLR in type 2 diabetes mellitus and its correlation with renal function. Method: This study is a cross-sectional observational study conducted at a tertiary care hospital. This study included 200 patients diagnosed with type 2 diabetes mellitus, 100 of whom had deranged renal functions and 100 patients had normal renal function. The control group was composed of 100 healthy age and sex-matched subjects. NLR was calculated and statistical analysis was made using student's t-test, post HOC test, and ANOVA. A value of P < 0.05 was considered significant. Results: When NLR was compared among three groups, NLR was significantly higher in diabetic patients as compared to controls and NLR was significantly higher in diabetic nephropathy group as compared to the diabetic with normal renal function group and control group. Conclusions: NLR is a novel, simple and inexpensive marker that can be used as a measure of systemic inflammation in diabetes and correlates with severity of diabetic nephropathy.

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Background: In India, there was an estimated 2.69 million new tuberculosis (TB) cases with 449,700 deaths in 2018 and it continues to be a major public health problem. Diabetes mellitus (DM) and poor glycemic control triple the risk of TB and adversely affect TB treatment outcomes. This study aimed to determine the risk of type 2 DM among TB patients registered under RNTCP using the Indian Diabetes Risk Score (IDRS). Materials and Methods: This was a community-based cross-sectional study conducted among 60 TB patients of rural field practice area of a medical college. A pretested semi-structured questionnaire with IDRS was used for the data collection. TB patients were categorized into low-risk, medium-risk, and high-risk categories of developing diabetes using the IDRS. Necessary statistical tests like simple proportions and Chi-square test were applied to test for association between categorical variables. Results: Of 60 TB patients, 19 (31.7%) were in high-risk category; 36 (60%) were in the medium risk category and 5 (8.3%) were in low-risk category of developing DM. Conclusion: Routine DM screening of TB patients in the community using IDRS is the most cost-effective tool where there are limited resources and infrastructure and also provides an early opportunity to decrease the twin burden of TB-DM.

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Vitamin B₁₂ deficiency is rare and presents with combinations of hematological changes, discoloration of skin, hair and nails, weakness, syncope, and diarrhea. Causes of vitamin B₁₂ deficiencies are malabsorption, pernicious anemia, gastric resection, and rarely inadequate intake. Inadequate intake occurs commonly in people having a strict vegetarian diet. Megaloblastic anemia has a slow onset when compared to that of other anemias. It results in defect in the red cell DNA synthesis and is mostly due to hypovitaminosis, specifically vitamin B12 deficiency. Hyperpigmentation of skin has been reported in medical literature as the presenting manifestation of vitamin B₁₂ deficiency.

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Pediculus humanus capitis or head louse, a blood-sucking, wingless arthropod, has been a source of repulsion and embarrassment causing social distress, parental anxiety, and absenteeism. The battle to eradicate this infestation has not been rewarding as the obligate parasite continues to produce resistance to effective first-line pediculicides such as permethrin. Abametapir is a new pediculicide that inhibits the metalloproteinases critical to the hatching process of the eggs. Being an ovicidal drug, it needs a single application. In two large phase 3 studies with 704 subjects aged ≥6 months, abametapir lotion eliminated lice in ≥80% of subjects after a single 10-min application with no nit combing. The common adverse effects observed are erythema, rash, and sensation of skin burning. The Food and Drug Administration approved abametapir lotion, 0.74%, for a one-time topical treatment of head louse infestation for patients aged 6 months and older in July 2020. Good efficacy, safety, and a novel mechanism of action make it a welcome addition to the list of effective lousicidal drugs.

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Purpose: Odontogenic fascial space infections are often unpredictable in their course of spread due to the anatomical connectivity of potential spaces. C-reactive protein (CRP) has been widely studied and accepted as a marker in monitoring acute phase of infection. The purpose of this prospective analytical study was to identify the efficacy of CRP in fascial space infections by analyzing the correlation of CRP levels with other parameters of inflammation. Methods: About 30 patients with fascial space infection who required incision and drainage (I&D) were included in the study. The clinical parameters of infection such as pain, temperature, swelling, and pus discharge were measured. Laboratory parameters such as serum levels of CRP, Erythrocyte Sedimentation Rate (ESR), and Total Leukocyte Count (TLC) were also estimated. The measures were analyzed prior to I&D on day 1, as well as on third, seventh, eleventh, and fifteenth day of I&D. The mean values at different time frames were analyzed statistically and spearman's correlation was performed to identify the relation of CRP with other parameters. Results: The mean CRP values dropped from 149.4 ± 81.8 ml/dl on the first day to 3.39 ± 0.9 mg/dl on the final day of assessment (P < 0.001). The CRP values demonstrated a significant positive correlation with ESR and TLC values and clinical parameters of infection. Conclusion: The results of this study suggest that CRP can be used as an effective marker and should be incorporated as a monitoring tool in the diagnosis and prognosis in patients with fascial space infections.

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Background: Most diabetic wounds are infected and eradication of the infected source is paramount to the success of healing. Antibiotic culture and sensitivity of samples aid in the assessment of the severity of the infection and the state of sensitivity or resistance of organisms in an infected ulcer to antibiotic treatment, thereby preventing or minimizing the necessity of amputation. Aims: To compare two methods of evaluating bacterial infection, wound swab culture (SC) against tissue sample cultures (TC), and determine sensitivity patterns and compare them for establishing the diagnosis of infected diabetic foot ulcers. Methods and Material: New-onset diabetic foot ulcers were subjected to tissue sampling and wound swabbing; specimens were cultured for aerobic and anaerobic organisms. a. Settings and Design: Prospective observational study at a tertiary care hospital done over two years. b. Statistical analysis used: Data was recorded in excel data sheet and statistically analysed by using the SPSS Ver 22.0. Results: Three hundred and eight micro-organisms were isolated from a cumulative total of 127 infected wounds (2.75 and 2.08 per wound for SC and TC, respectively). Sensitivity and specificity were 82.27% vs 78.48% and 71.43% vs 52.38% for the SC and TC groups, respectively. The maximum concordance was noted in the Grade 2 ulcer group (73.84%). Conclusion: Wound SCs were comparable to TCs for Grade 2 ulcers. For higher grades of ulcers, tissue sampling method is recommended.

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Post-acute Coronavirus Disease 2019 (COVID-19) syndrome is currently an emerging condition, however, there is only a little research information on these post-COVID-19 symptoms, especially auditory manifestations, which have been in the limelight recently among the COVID-19 recovered patients. Tinnitus and conductive/sensorineural hearing loss were the most commonly reported manifestations post-COVID-19, while vertigo, otitis externa, and ear pain were the least reported. Here, we have discussed relevant auditory manifestations in theoretical and practical terms; considering the mechanisms of causation, published literature on auditory involvement in patients post-COVID-19, and during the active stage of the disease, and whether this could result in long-term complications.

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Introduction: It has been observed that there is inadequate retention of microbiology and its inappropriate application to clinical science among medical graduates. To address this problem and facilitate student's learning, we need to adopt active, student centric teaching learning methods. Case-based learning (CBL) is one such method .The present study was planned to introduce Case Based Learning (CBL) in Microbiology and assess its advantages in understanding the topic in comparison to traditional didactic lecture and to observe perception regarding CBL among faculty and students. Material and Methods: 96 MBBS second Prof Students were enrolled in the study after obtaining informed consent and Institutional Ethics Committee approval. Theory lectures and CBL sessions were taken on the selected topics. At the end of both, the lectures and CBL sessions, a post test (MCQ) was conducted. A repeat test was taken after 4 weeks from the first post-test (MCQ) for each topic to see the retention of topic. Feedback of students and faculty were taken on a pre-validated questionnaire and analysed using a 5 point Likert scale. Results: A total of 96/100 (96%) students participated in the study. The CBL scores were significantly higher than DL session scores (P < 0.001). The difference in scores was significant even after four weeks of session (P < 0.001). Student reported satisfaction in being taught by CBL method in 5-point Likert scale feedback form (mean score >4) and recommended it for future batches. Conclusions: The study concludes that Case Based Learning is an active method of student centric learning resulting in better understanding, critical analysis, communication and retention of subject topics among students. The faculty also approved of the method in spite of being demanding and lack of adequate resources opining that the method is of special use in discussing clinically relevant topics.

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Renal synovial sarcoma is a rare disease with less than 200 cases reported in the literature. A 36-year-old lady presented with hematuria and underwent radical nephrectomy for a left-sided renal synovial sarcoma. She developed lung metastasis and the disease progressed further despite of chemotherapy. Renal synovial sarcoma can be diagnosed by studying morphology and performing an Immuno-histochemistry (IHC) panel (Transducin-like enhancer of split (TLE); B Cell Lymphoma (BCL)-2; CD99) on resected tumor tissue. Molecular testing for t(x; 18)(p11.2;q11.2) translocation is considered the gold standard diagnostic test. The common presenting symptoms include hematuria, pain, or a palpable lump. The imaging modalities are not diagnostic and surgical resection is the treatment of choice at present. Due to the rarity of the disease, the treatment guidelines are not well-defined. Anthracyclines alone or in combination with Ifosfamide has been reported to be used in the literature in the adjuvant as well as metastatic settings. The overall prognosis is poor with a short median survival ranging from 6 to 24 months.

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Anti-tubercular therapy (ATT) drugs are the mainstay of management of tuberculosis worldwide. These medicines are used extensively across the globe in treating tubercular infections of any organ. The life-threatening complications of pseudomembranous enterocolitis (PMC) associated with ATT, especially with capsule Rifampicin is not known to most practitioners. An early suspicion during the onset of loose stools in a patient on ATT is essential for managing this life-threatening condition. This fatal case report is to create awareness among the healthcare professionals and sensitize the clinicians, about the possibility of PMC in patients on ATT. We discuss our case and the lessons learnt in this case report.

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