IntroductionEvidence on new-onset endocrine dysfunction and identifying whether the degree of this dysfunction is associated with the severity of disease in patients with COVID-19 is scarce.Patients and MethodsConsecutive patients enrolled at PGIMER Chandigarh were stratified on the basis of disease severity as group I (moderate-to-severe disease including oxygen saturation <94% on room air or those with comorbidities) (n= 35) and group II (mild disease, with oxygen saturation >94% and without comorbidities) (n=49). Hypothalamo-pituitary-adrenal, thyroid, gonadal axes, and lactotroph function were evaluated. Inflammatory and cell-injury markers were also analysed.ResultsPatients in group I had higher prevalence of hypocortisolism (38.5 vs 6.8%, p=0.012), lower ACTH (16.3 vs 32.1pg/ml, p=0.234) and DHEAS (86.29 vs 117.8µg/dl, p= 0.086) as compared to group II. Low T3 syndrome was a universal finding, irrespective of disease severity. Sick euthyroid syndrome (apart from low T3 syndrome) (80.9 vs 73.1%, p= 0.046) and atypical thyroiditis (low T3, high T4, low or normal TSH) (14.3 vs 2.4%, p= 0.046) were more frequent in group I than group II. Male hypogonadism was also more prevalent in group I (75.6% vs 20.6%, p=0.006) than group II, with higher prevalence of both secondary (56.8 vs 15.3%, p=0.006) and primary (18.8 vs 5.3%, p=0.006) hypogonadism. Hyperprolactinemia was observed in 42.4% of patients without significant difference between both groups.ConclusionCOVID-19 can involve multiple endocrine organs and axes, with a greater prevalence and degree of endocrine dysfunction in those with more severe disease.

Background: Diabetes mellitus is the most common metabolic disorder characterized by metabolic abnormalities and long term complications. The chronic complications of diabetes mellitus affect many organ systems and are responsible for the majority of morbidity and mortality associated with the disease. The aim of the study is to estimate the serum fibrinogen level in patients of Type 2 diabetes and correlate it with parameters like glycemic control (HbA1C), duration of diabetes mellitus, complications and pharmacotherapy. Methods: The study was conducted at the medicine department of J. A. Group of Hospital & G. R. Medical College, Gwalior, included patients of type-2 diabetes mellitus with or without microvascular complications between the ages of 25-85 years of either sex. Total 60 patients were selected randomly divided in two groups: Group A (n=34) was type-2 diabetes mellitus with microvascular complication, Group B (n=26) was type-2 diabetes mellitus without microvascular complication and Group C (n=28) was non diabetic healthy control. Patient's history, clinical examination, routine blood tests, serum fibrinogen level and fundus examination were carried out. Serum fibrinogen was measured by Clauss method. Results: Maximum number of patients in study was between 40-60 years' age group. Microvascular complication in Group A were nephropathy (n=17), retinopathy (n=13) and neuropathy (n=4). Serum fibrinogen level in patient with microvascular complications, without microvascular complications and in non-diabetic controls were 515±138.7, 437±137 and 308±52.65 respectively. Serum fibrinogen level was higher in overweight patients as compared to normal weight patient in all groups. Serum fibrinogen level in different albuminuria groups (<30mg/l, 30-300mg/l, >300mg/l) were 439.7±135.15, 525.7±145.4, 545.7±112.2 respectively. Mean fibrinogen level was 541.1±121.7 in diabetics with total cholesterol >200. Serum fibrinogen level in patients with HbA1C >12% among both group A & B was 567.5±173.4 and 538.6±184.6 respectively. Most of type-2 diabetes mellitus patient have high fasting blood sugar >126 and high PPBS >200 in both group A & B. Mean fibrinogen level in patients taking insulin, oral hypoglycemic agents and in patients who were not taking any treatment was 640.8±126.4, 449.9±145.7, 419±72 respectively. Conclusions: Further larger studies are required studying the serum fibrinogen level in diabetic patients with microvascular complications and effect of interventions done to reduce the fibrinogen levels.

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Background: Influenza is known to cause annual seasonal epidemics in Asian subcontinent. Our study assessed the clinical profile, factors influencing the response, prognosis and outcome in H1N1 positive patients during FebruaryMarch 2015. We aimed to understand the epidemiology and patterns of the disease so that the high risks groups could be identified. Methods: Medical records of the patients who were admitted during Feb-March 2015, as a suspected case to the swine flu ward of J A Hospital and G R Medical College, Gwalior, India were manually retrieved and retrospectively studied. H1N1 positive patients, who were diagnosed clinically and confirmed by RT-PCR method, were included for analysis. Results: Out of 208 patients were admitted for suspicion of swine flu influenza and underwent testing out of which 88 (42.30%) were found to be positive for H1N1. Most common (37.40%) affected age group was 20-30 years. Females were more involved (62.5%), out of which 20% were antenatal. The common presenting symptoms were cough, fever, breathlessness. Overall case fatality ratio was 4.45%. Conclusions:Patients with influenza like illness should not panic as many of them become negative for H1N1. In our area prevalence of H1N1 was high in young and females. Most of the patients recovered with symptomatic treatment and oseltamivir therapy. Proper prevention steps, personal hygiene and admission to designated swine flu ward can be helpful in preventing the spread in the community.

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