Introduction Hyper-cytokinemia is a dreaded complication of severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2) infection and an important predictor of mortality in coronavirus disease 2019 (COVID-19). The current evidence at best is still ambiguous for use of tocilizumab in cytokine storm in COVID-19. Moreover, the factors that are associated with beneficial response from tocilizumab are unknown in COVID-19. We aimed to study the clinical outcomes especially mortality vis-à-vis clinical and laboratory characteristics of patients administered tocilizumab and identify predictors of mortality benefits amongst deceased vs recovered COVID-19 patients. Methods The present study is a retrospective observation of the demographic, clinical, and biological data of all the consecutive patients treated with tocilizumab for COVID-19 pneumonia at the COVID tertiary care centre from July 2020 to October 2020 at Ahmedabad, India. We compared the deceased group with those who recovered/discharged and evaluated patient-level demographics, clinical attributes, and laboratory investigations available to identify subgroups in whom tocilizumab reduced mortality. Results Of the 112 patients included, the mean (SD) age was 56.84 ± 13.56 years and 80 (71.4%) were male. There were 97 (86.6%) patients in the survivors and 15 (13.39%) in the deceased group. Deceased were older than the recovered group (mean: 66.14, SD: 14.41 vs mean: 55.36, SD: 12.98; p=0.04). Hypertension (33.03%) was the commonest comorbidity observed. Mortality was significantly higher in patients with cancer and type-2 diabetes (p=0.05 and p=0.01, respectively). Level of D-dimer and lactate dehydrogenase (LDH) showed trends towards significance as a predictor of mortality (p=0.07 and p=0.08, respectively) not reaching significance. D-dimer level > 5,000 nanograms per millilitre (ng/mL) was the significant predictor of subsequent deaths (p<0.0001). Fourteen patients reported adverse events of tocilizumab. Patients who developed in-hospital complications (such as septic or vasodilatory shock and/or sepsis, acute kidney injury, multiorgan dysfunction) had significantly higher mortality (p<0.0001, p=0.009, and p=0.03, respectively). Conclusion Tocilizumab might be more beneficial in younger patients without sepsis/ septic shock, acute kidney injury, multiorgan dysfunction, and who were non-ventilated. The predictors of mortality amongst Asian Indians treated with tocilizumab were older patients, the presence of type-2 diabetes, cancer, in-hospital complication (such as acute kidney injury, sepsis/septic shock, multiorgan dysfunction), higher D-dimer > 5,000 ng/mL. A larger study with pre-defined inclusion cutoffs of these variables may aid in defining patient's characteristics of Asian Indians who may benefit from tocilizumab in COVID-19.

The coronavirus disease-2019 (COVID-19) pandemic is exacerbating the worldwide healthcare crisis. The pandemic has had an impact on nearly every system of our body. The Food and Drug Administration (FDA) gave immediate authorization of several vaccines to avoid critical COVID-19 outcomes following the rapid spread of the COVID-19. There have only been a few cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination-induced immune thrombocytopenia (ITP) so far. There should be enough information to identify whether some vaccination adverse effects, such as ITP, are caused by the vaccine. This study aims to determine how common ITP occurs after receiving the SARS-CoV-2 vaccine, as well as gender, age, symptoms, biomarkers, predicted outcomes, and sequelae. We looked at a number of research and compiled the best evidence of SARS-CoV-2 vaccine-induced thrombocytopenia currently available. To find the recommended reporting items, the search technique included keywords like "Immune thrombocytopenia," "COVID-19," "SARS-CoV-2," and "Vaccination." The search results were grouped using Boolean operators ("OR," "AND").

Due to the rapid development of the coronavirus disease 2019 (COVID-19) pandemic, the Food and Drug Administration (FDA) expedited the authorization of immunizations to counteract life-threatening COVID-19 effects. COVID-19 immunization was seen as an essential component of surviving endemically with COVID-19. Although there were no major adverse event reports that mandated an early authorization of the mass vaccination approval in initial studies, a few significant adverse events were reported after real-world usage. The most prevalent adverse events are regional reactions, such as discomfort at the injection site. Anaphylactic shock and acute responses were quite infrequent. Current evidence strongly convince the community that the advantages of immunization outweigh the risks.The review investigates the potential adverse reaction in the form of myocarditis caused by the COVID-19 vaccine. Age, sexuality, vaccination type, clinical manifestations, and diagnostic modalities were among the confounding factors associated with vaccine-induced myocarditis. This picture depicts COVID-19 immunization-induced myocarditis and the treatment options available to practitioners. Further evaluation is needed to establish the underlying cause of this association. We compiled the most recent data on SARS-CoV-2 vaccine-induced myocarditis after reviewing available research. Information sources including PubMed and Google Scholar were evaluated retrospectively.

In the early pandemic, it was brought to attention that individuals with Diabetes Mellitus (DM) are prone to a more severe form of Coronavirus Disease 2019 (COVID-19). With this in mind, healthcare professionals need to be vigilant about their patients’ medical history in these challenging times as this could change the course of treatment and follow-ups for someone with COVID-19 and DM. Moreover, this is of utmost importance as the coronavirus is deemed to thrive in the elevated blood glucose environment. Though there is little known about the best medications for glycemic control in COVID-19, however, there are multiple other factors that can be beneficial in exploring for management in DM patients who are infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and some of these factors are as follow adequate glycemic control, medication dosages adjustment, diet, physical guidelines, thromboembolism prophylaxis, and empirical treatments for the possible co-infections. We conducted a literature review of publicly available information to summarize knowledge about the correlation between Diabetes Mellitus and the COVID-19 infections. The main objective of this manuscript is to provide a brief overview of the potential pathophysiologic correlation of DM and COVID-19, optimal management and prevention.

Purpose: To find out correlation of swap and OCT in preperimetric glaucoma patient coming to Dhiraj general hospital. Materials and Methods: A complete ophthalmological examination will be done including uncorrected and best corrected visual acuity, slit lamp examination, central corneal thickness measurement by pachymetry, applanation tonometry, gonioscopy and dilated fundus examination and Humphrey perimetry followed by SWAP and FDT. Result: In the present study a total of 50 patients were screened. Out of this 22 patients had a CDR of 0.5 with healthy neuroretinal rim (HNRR) in both the eyes. One patient had 0.5 CDR with inferior thinning in both the eyes. 8 patients had a CDR of 0.6 with HNRR and 1 had 0.6 CDR with inferior thinning. 2 patients had a large cup to disc ratio of 0.7 CDR but the neuro retinal rim on clinical examination appeared to be healthy. 14 patients had a large cup to disc ratio of 0.7 in both the eyes. Out of this 8 had inferior thinning of the neuro-retinal rim and 6 had superior thinning of the neuro retinal rim. 2 patients included in this study had 0.8 CDR with one having superior thinning and one having inferior thinning of the neuro retinal rim. The accuracy of OCT in detecting even the smallest nerve fiber layer defect was much higher than seen on SWAP. About 52% showed normal OCT as compared to perimetry group which was 60% and about 48% of patients showed affected nerve fiber layer thinning as compared to perimetry where visual field changes were 40%. Conclusion:In this study it was concluded that SD-OCT is better in detection very early stages of glaucoma where SAP or SWAP modality of perimetry does not detect. The sensitivity of OCT is much higher than perimetry and can help in detecting the suspects of glaucoma. Patients at with high risk (family history, smokers, large cup to disc ratio etc) should be screen for both OCT and SWAP. This will help us for manage patients better as they will be detected at a very early stage.