Bommenahalli Gowda et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 4.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Background and objective Neutrophils are primarily responsible for activating the immune system, and systemic inflammation destroys CD4+ T lymphocytes and increases suppressor CD8+ T lymphocytes, thereby leading to an increased neutrophil-to-lymphocyte ratio (NLR). An increase in the apoptosis of lymphocytes leads to lymphopenia and elevated thrombopoietin (THPO) promotes megakaryocyte production. The reflections of these inflammatory changes can be vital in gauging the progression of the disease. This study aimed at examining the prognostic value of normal and derived neutrophil-to-lymphocyte, lymphocyte-to-monocyte, platelet-to-lymphocyte, and mean platelet volume (MPV)-to-platelet count ratios in patients with coronavirus disease 2019 (COVID-19). Methodology This was a retrospective cross-sectional study conducted in the wards of Chigateri General Hospital, Davangere for a period of two months. Complete blood count was ordered for all patients at the time of admission along with confirmation of the disease by reverse transcription-polymerase chain reaction (RT-PCR). Results The final study population consisted of 100 patients. The mean age of patients who survived (43 years) was significantly lower than the mean age of non-survivors (59.1 years), with a p-value of <0.001. NLR was raised in 60% of the population and was significantly higher in patients who survived the disease, with a p-value of 0.004. The platelet-to-lymphocyte ratio (PLR) also followed a similar trend with a p-value of 0.017. Even though the lymphocyte-to-monocyte ratio (LMR) also mimicked the trend, the statistical association was not significant (p-value: 0.09). The derived NLR and MPV-to-platelets ratios were not found to be significantly associated with mortality in this study. Discussion Younger patients had better clinical outcomes in our study population compared to the geriatric age group. A significant correlation between LMR and mortality was observed when a cutoff of 2.5 was considered as a differentiating benchmark. Conflicting trends were observed in NLR and PLR in our study; however, LMR was in accordance with most other studies. The phase that a patient is in with regard to the natural history of the disease also influences the blood cell ratios. Nonetheless, all three ratios can be used as crucial screening and prognostic tools as they are readily available with the help of a complete hemogram. This is an investigation modality that is widely accessible even in remote areas and resource-limited settings. Conclusion These hematological ratios can facilitate in categorizing the disease severity and progression in patients, thereby enabling us to make appropriate and informed clinical decisions. Since the second wave of the novel coronavirus is on the verge of arrival, it is imperative to channel resources for the patients early in their disease course to ultimately prevent complications and reduce mortality.

Introduction Dengue fever is endemic in more than 100 countries. Early indicators of prognosis are vital to reduce the fatality rate associated with dengue fever. The objective of this study is to investigate the value of a complete blood count (CBC) in determining the prognosis of dengue fever. Methodology This was a retrospective study of all patients admitted to Chigateri General and Bapuji hospitals, Davangere over two months. Fifty-six patients were included in the study. Medical records were accessed to obtain data on the clinical profile and laboratory investigations. Results Thrombocytopenia was the most common hematological feature, in 50 cases (~90%), followed by leukopenia in 43 cases (~76%). The duration of hospital stay ranged from two to seven days. Interestingly, the percentage of lymphocytes in the differential leukocyte count at the time of admission showed a significant negative correlation with the duration of hospital stay (p=0.028). Also, three distinct trends were observed in the sequence of recovery of platelets and white blood cells (WBCs). Discussion A repertoire of prognostic indicators have been described to predict the course and outcome of dengue fever: liver enzymes, interleukins 4 and 10, tumor necrosis factor α (TNFα), some proteases, soluble adhesion molecules, the surface area of atypical lymphocytes, high fluorescent lymphocyte counts, immature granulocytes and immature platelet factor (IPF). However, these markers are not routinely employed due to financial constraints and lack of infrastructure. The percentage of lymphocytes in the differential leukocyte count performed at the time of admission predicted the length of hospital stay. The higher the percentage of lymphocytes, the faster the recovery from dengue and shorter the duration of stay in the hospital. This is particularly important in remote areas with limited laboratory facilities. High-risk patients can be referred to a higher centre before they develop complications of the disease. Conclusion The complete blood count can function as an early indicator of prognosis in dengue fever even in areas where sophisticated biomedical infrastructure is lacking. The lymphocyte percentage on admission could significantly predict the length of hospital stay.

Rabson-Mendenhall syndrome (RMS) is a rare autosomal recessive disorder characterized by severe insulin resistance, a condition in which the body’s tissues and organs do not respond appropriately to the hormone insulin. Insulin resistance impairs blood sugar regulation and ultimately leads to diabetes mellitus. A 19-year-old male presented with joint pain, blurring of vision, and generalized weakness. Investigations revealed hyperglycemia (random blood sugar (RBS) > 625 mg/dL, glycosylated hemoglobin (HbA1c) 18%), as well as sugars, protein, and ketone bodies in urine routine examination. An ultrasound of the abdomen was normal. Cardiac status was normal. Based on the clinical features, particularly the head to toe examination, skin changes, and the onset of type 2 diabetes mellitus, RMS syndrome was considered. The joint pain was alleviated with intravenous tramadol. Actrapid®, a fast-acting insulin, was given to control sugar levels, along with metformin. Vitamin B12 and pregabalin were also supplemented. A dermatological cream containing ammonium chloride, calcium lactate, glycerin, potassium chloride, sodium dihydrogen phosphate, and urea was given for skincare. It is an extremely rare disease with a frequency of fewer than one million people worldwide. Most patients survive only up to 15 years of age, although some can live into their third decade of life. Hepatic gluconeogenesis and fatty acid oxidation are affected, leading to ketoacidosis. The progression is much faster in RMS. In RMS, the genetic defect affects the insulin receptor (INSR) gene transcription with non-sense mutations and causes splicing defects. This results in premature chain termination and eventually to lower amounts of the insulin receptor messenger ribonucleic acid (mRNA). Ultimately, the number and density of insulin receptors in the plasma membrane are smaller, making the cells resistant to insulin. Herein, we report the case of a 19-year-old patient with RMS who was treated in our hospital, leading to a successful improvement in symptoms and discharge of the patient.

Background and objectiveEmergency physicians come across a myriad of medical afflictions resulting from suicide attempts. The Indian contribution to global suicide deaths is alarming; the social construct of India is unique, and so are the problems and challenges. This study aims to describe the social background, demographic parameters and correlate the clinical profile and outcomes of all patients presenting with an attempted or completed suicide.

Medical literature is home to fancy descriptions, poetic metaphors, and ingenious comparisons. However, some comparisons can disguise the knowledge gap. Large surfaces in the human body, like the alveolar surface for gas exchange, villi for food absorption, and the endothelial lining of blood vessels, are frequently compared to a "tennis court."This narrative review explores this metaphor in detail, the discrepancies and factual inaccuracies across medical literature. It highlights the inappropriate use of Euclidean geometry and introduces fractal geometry, a language to define roughness.

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BACKGROUND Chronic liver disease is the progressive destruction of liver for 6 months thereby impairing clotting factor formation, bile metabolism, and protein synthesis. ChildPugh-Turcotte (CTP) score, model for end-stage liver disease (MELD) and MELD– sodium (Na) are well established calculated parameters to predict prognosis in chronic liver disease (CLD) patients. This study was conducted to determine as to how aspartate aminotransferase : platelet ratio index (APRI) fares in predicting adverse outcomes and prognosis among patients with chronic liver disease compared to other liver scoring. METHODS This was a cross-sectional hospital-based study of inpatients admitted in the department of General Medicine at Chigateri General Hospital. MELD, MELD-Na, Child-Pugh-Turcotte score, and APRI index, were applied and calculated on all the 50 patients to stage the chronic liver disease, and were followed up for 3 months. RESULTS 19 patients survived and 31 patients died. Among the 31 dead patients, 24 had MELD score of greater than 21.5 points. Sensitivity of MELD & MELD-Na in predicting mortality was 77.42 %. Diagnostic accuracy for both scores was 74 %. All patients who died had a Child Pugh score of greater than 10. The sensitivity of CTP scoring was 100 % and diagnostic accuracy was 98 %. 76 % of our patients experienced severe fibrosis according to APRI index. 4 % experienced significant fibrosis. 20 % of the patients did not have significant fibrosis. The least sensitivity (61.29 %) and diagnostic accuracy (62 %) was observed with APRI. However, positive predictive value was 73.08 % and diagnostic accuracy was 65 % for mortality. CONCLUSIONS Given the minimal investigations required in calculating APRI, it can be used as a fair indicator predicting status of the patient especially in resource limited settings. KEYWORDS Child Pugh Turcotte Score, APRI Index, MELD Score, MELD Na Score