BackgroundNovel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (or coronavirus disease 2019; has caused a large number of infections across the globe. Numerous markers are being used to predict the severity of infection. This study was undertaken to assess the utility of platelet count, mean platelet volume (MPV), platelet distribution width (PDW), and platelet lymphocyte ratio (PLR) as markers of severity and mortality among patients with COVID-19 infection. MethodologyThis is a retrospective study conducted in a tertiary care center in India from April 2021 to June 2021. Patients admitted with COVID-19 infection were included in the study. Based on the severity, patients were categorized into the mild and severe (moderate severity included) groups. Platelet count, MPV, PDW, and PLR done at admission were studied and correlated with the disease severity and mortality. StatisticsThe independent t-test was used to compare the variables. The receiver operating characteristic (ROC) curve was done to identify the cut-off value. Statistical analysis was performed using SPSS 18 software (SPSS Inc. Released 2009. PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc). ResultsOne hundred patients admitted with COVID-19 infection were studied. 51 patients had a mild and 49 had a severe infection. The mean PLR was 141.40 among patients with mild illness and 252.6 with severe infection (P<0.001). The mean PLR among survivors was 104.4 (SD-23.56) and among nonsurvivors was 302.78 (SD-34.5) (P<0.001). There was no statistically significant difference between the two groups with respect to platelet count, MPV, and PDW. ConclusionPLR was found to be a reliable marker of severity and mortality among patients with COVID-19 illness.

Background: The incidence of severe sepsis and septic shock has increased over the past 30 years, and the annual number of cases is now >700,000 (~3 per 1000 population). There are many markers of sepsis which are being evaluated for its diagnosis among which RDW is emerging as a promising marker. Hence this study is being done to see the correlation between RDW and sepsis.Methods: A total of 162 patients-81 survivors and 81 non-survivors of severe sepsis and septic shock fulfilling inclusion and exclusion criteria who were admitted to intensive care unit between October 2013 and September 2015 were included in the study. Baseline variables, laboratory parameters, complications, and RDW were compared between the two groups.Results: Majority of patients - 73(45.06%) were in the age group of 61 - 80 years. Mean RDW was 15.20±2.29 in non-survivors and 13.86±2.20 in survivors, which was statistically significant (p<0.001). Mean RDW was higher and statistically significant among non-survivors with respect to duration of stay and requirement of inotropes.Conclusions: RDW levels measured on admission can be used as a prognostic marker in patients in severe sepsis and septic shock.

Thyrotoxic Periodic Paralysis (TPP) is an uncommon disorder. Though many cases of hypokalaemic periodic paralysis are reported in overt hyperthyroidism, hypokalaemic paralysis in subclinical hyperthyroidism is very rare. Subclinical hyperthyroidism is characterised by circulating TSH levels below reference range and normal thyroid hormone levels. We describe a case of 32-year-old Asian male who presented to the emergency department with acute onset weakness and hypokalaemia with no previous history of thyroid disorder or any signs and symptoms suggestive of hyperthyroidism. He was subsequently diagnosed with Graves' disease with subclinical hyperthyroidism.

Introduction: The pandemic caused by SARS Corona Virus-2 (COVID-19) has caused widespread mortality globally. The hallmark of the disease is the "cytokine storm," which is caused due to dysregulated immune system activation. Numerous inflammatory markers are used to predict the severity and mortality of the infection. Serum Cystatin C levels are associated with immune responses to exogenous and endogenous antigens. Our study was done to assess serum cystatin C as a marker of severity and mortality among patients admitted with COVID-19 infection. Methodology: This cross-sectional study was conducted in a tertiary care center in South India. Sixty-nine patients with mild and severe COVID-19 infection admitted to the hospital were included in the study. Serum Cystatin C levels were estimated at admission. The levels were correlated with disease severity and mortality. Receiver operating characteristic curves (ROCs) was constructed for Cystatin C to predict severity and mortality. The computation of sensitivity, specificity, and positive and negative predictive values was done using optimal cut-off points. SPSS 18 was used for the statistical analysis. Version 18.0 of PASW Statistics for Windows. SPSS Inc., Chicago. Results: Out of 69 patients, 28 (40.5%) had a mild illness, and 41 patients (59.4%) had severe COVID-19 illness. Mean serum Cystatin C levels measured at the time of admission among patients with mild illness was 1.83 (SD-1.53), and among patients with severe illness was 3.84 (SD- 2.59) (p<0.001). The area under receiver operating characteristic curves (ROC) for serum cystatin C for predicting COVID-19 severity and mortality was 0.904 and 0.768, respectively (p<0.001). Conclusion: Patients with severe COVID-19 disease had considerably higher serum levels of Cystatin C than those with mild COVID-19 illness. Cystatin C levels can be useful for predicting mortality and severity among patients admitted with COVID-19 infection.

Neuromyelitis optica spectrum disorders (NMOSDs) are rare immunological inflammatory disorders of the central nervous system (CNS) primarily involving the optic nerve, spinal cord, and brain. [1][2][3] It is more common, has younger age of onset, has higher brain/brainstem involvement in Africans and Asians than Caucasians, and is usually diagnosed in middle-aged females. 2,4 The majority of NMOSD patients have positive AQP4-Ab. 1 Diagnosis of NMOSD is based on International consensus diagnostic criteria, requiring certain clinical, laboratory, and imaging criteria to be met with the exclusion of differentials. 5,6 Acute attacks are primarily managed with intravenous corticosteroids. 1 In worsening cases, plasma exchange may be indicated. 1 Also, monoclonal antibodies, such as rituximab, eculizumab, tocilizumab, satralizumab, etc., can be used to modify the course of the disease. 7,8 Early diagnosis and intervention are crucial to prevent worsening and ensure optimum quality of life in these patients. 9,10 Herein, we present the case of a middle-aged Asian male with NMOSD with AQP4-IgG. | CASE REPORTA 52-year-old Asian male presented with multiple episodes of hiccups, vomiting, decreased bladder sensation,