The COVID-19 disease continues its rampage on the human population all over the world. The pathogenesis mechanisms involve various inflammatory and altered immune responses and oxidative processes, leading to complications like cytokines storm and death in vulnerable cases. Therefore, in this review, we summarize current evidence on melatonin therapy for viral infections with focus on possible underlying mechanisms of melatonin actions. Since this pandemic crisis elapses time, researchers worldwide are busy trying new solutions to overcome the heavy toll of the COVID-19 illness morbidity and mortality. One such drug with growing recognition is melatonin. Melatonin is a well-known anti-inflammatory and antioxidant molecule which helps in promoting adaptive immunity. Melatonin improves sleep and anxiety and also can prevent fibrosis. It is a readily available over-the-counter medication that can be manufactured easily in bulk, hence inexpensive to a patient from a developing nation like India. It can be orally administered and has a wide margin of safety. This article reviews the various facets, merits, demerits, and rationale of the re-use use of molecule melatonin, which is yet to be recognized.

Varicose veins are very common clinical condition characterised by permanently dilated torturous elongated veins in the leg which is due to incompetence of valves. Risk factors being heredity, occupations of prolong standing, immobility, raised intra abdominal pressure, raised progesterone level, altered oestrogen-progesterone ratio etc. A 27 years old patient with no h/o any systemic disease or co morbidities came with complaints of dilated, tortuous veins in the left lower limb extending from mid-thigh to ankle region since 2 months. Since 1 month the patient was having dull aching pain over the left lower limb on walking and prolonged standing. A thorough clinical examination was done with findings of incompetent Sapheno-femoral junction(SFJ) and perforator incompetence of the left lower limb. A venous Doppler of the left lower limb revealed SFJ dilated and incompetent and Incompetent perforators along the GSV 5 cm below the knee. Following all routine preoperative work-ups, patient was posted for surgery. After ligating all the tributarirs of GSV, while checking the metallic stripper, it snapped in between and was not in a useable condition and there was no other metallic stripper in the OT. Decision had to be taken for an alternative the GSV was sucessfully stripped using a 14F Neltons catheter. Thus as an alternative to metallic stripper, a Neltons catheter can also be used for stripping varicose veins.

No abstract

The COVID 19 pandemic continues its havoc over the last six months in India. The present study of the initial phase of illnesses in mild to moderate cases of SARS-COVID is the rampant community transmission. This observational and cross-sectional study aimed to analyse and correlate the socioeconomic and demographic parameters with clinical and psychosocial presentations of the COVID disease through a questionnaire-based interaction Mild and moderate COVID positive patients with stable hemodynamic were enrolled for the study. The findings revealed that of the 179 patients, the majority of patients were adults below 60 years of age group, followed by the older age group above 60. Males had a slightly higher preponderance than females. The majority of people in their families were medium to big and overcrowded, lacked social distance and poor hygiene practises were partially attributable to bad social economic conditions. Most of the patients originated from the red area, i.e. high-risk zone, as well as the high level of transmission of COVID illnesses to human beings. The majority of patients were in the poor and lower middle classes (Kuppuswamy modified scale).Most of the occupations of COVID patients involved the lower strata labour jobs. Fifty percent of patients had no symptoms at onset and remained asymptomatic throughout the illness. There were many issues and insecurities in most patients relating to the current illness, future well-being of families, job and financial concerns that warrant strategies to be implemented during and in post COVID era.

Ever since the human race has been exposed to the novel COVID 19 illness, newer and newer intriguing features of the COVID viral plethora are seen with each passing day. Many manifestations of the COVID 19 illness have been baffling and unexplainable to researchers currently. One such unusual presentation seen is ‘happy hypoxia’ or silent hypoxemia in a third of patients' total number. This review article is intending to put some light on the puzzling condition of happy hypoxia. We authors refer you through various theories postulated for happy hypoxia. It has definite clinical implications in the sense that it can be lifesaving if detected early and promptly in a COVID patient. We conclude that happy hypoxia or silent hypoxemia is a new entity and should be diagnosed with a high index of suspicion in COVID suspect patients in both young patients with no co morbidities and the elderly and diabetics. Diagnostic modalities like pulse oximeter should be widely used at hospitals and clinics and for self-monitoring by the patients at homes. Also, chest X-rays or HRCT imaging of the lungs is essential in the early stages to identify the early infective changes with compromised lung function and rule out this happy hypoxia. Also, further research is essential to find the exact ethologic of this subclinical though ominous prognostic entity.