The Epidemiological and Mycological Profile of Superficial Mycoses in India from 2015 to 2021: A Systematic Review

Background: The epidemiological and mycological patterns of superficial mycoses across various geographic regions of India across the last few years are changing. Objective: This study was performed to evaluate the epidemiological and mycological profile of superficial mycoses in India between 2015 and 2021. Methods: In this systematic review, the PubMed database was searched for all observational studies published between January 1, 2015, and December 31, 2021, which had evaluated the clinico‑mycological profile of superficial mycoses among outpatients from various parts of India. Descriptive statistics was used to represent the results. Results: Forty studies(21 from the north, three from the northeast, five from the east, seven from the south, one from the west, and three from multiple regions of India) were included. Male patients and those of the age group of 21–40 years were most commonly affected. The proportion of dermatophytes as causative organisms was consistently high across all regions and throughout the study period (23.6%–100%). Among dermatophytes, the proportion of Trichophyton mentagrophyte (14.0%–97.2%) and Trichophyton rubrum (0%–69.1%) was consistently high across all regions. The prevalence of T. mentagrophyte showed a rising trend, while that T. rubrum showed a declining trend from 2015 to 2021. Conclusions: The epidemiological and mycological pattern of superficial mycoses showed a fairly similar trend across various regions of India from 2015 to 2021. Dermatophytes were the main causative agents of superficial mycoses; the most common species were T. mentagrophyte and T. rubrum. A rising trend of T. Mentagrophyte infection was found.

Variability of the EG95 antigen-coding gene of Echinococcus granulosus in animal and human origin: implications for vaccine development

In the present study, the genetic variability of the EG95 protein-coding gene in several animal and human isolates of Echinococcus granulosus was investigated. A total of 24 isolates collected from cattle, buffalo, sheep, goat, dog and man were amplified by Eg95-coding gene-specific primers. From the generated sequence information, a conceptual amino acid sequence was deduced. Phylogenetically, the Eg95 coding gene belongs to the Eg95-1/Eg95-2/Eg95-3/Eg95-4 cluster. Further confirmation on the maximum composite likelihood analysis revealed that the overall transition/transversion bias was 2.913. This finding indicated thatthere is bias towards transitional and transversional substitution. Using artificial neural networks, a B-cell epitope was predicted on primary sequence information. Stretches of amino acid residues varied between animal and human isolates when hydrophobicity was considered. Flexibility also varied between larval and adult stages of the organism. This observation is important to develop vaccines. However, cytotoxic T-lymphocyte epitopes on primary sequence data remained constant in all isolates. In this study, agretope identification started with hydrophobic amino acids. Amino acids with the same physico-chemical properties were present in the middle. The conformational propensity of the Eg95-coding gene of 156 amino acid residues had α-turns and β-turns, and α-amphipathic regions up to 129, 138–156 and 151–155 residues, respectively. The results indicated potential T-cell antigenic sites. The overall Tajima’s D value was negative (−2.404165), indicative of negative selection pressure.

Addressing healthcare needs of people living below the poverty line: A rapid assessment of the Andhra Pradesh Health Insurance Scheme.

Background. Families living below the poverty line in countries which do not have universal healthcare coverage are drawn into indebtedness and bankruptcy. The state of Andhra Pradesh in India established the Rajiv Aarogyasri Community Health Insurance Scheme (RACHIS) in 2007 with the aim of breaking this cycle by improving the access of below the poverty line (BPL) families to secondary and tertiary healthcare. It covered a wide range of surgical and medical treatments for serious illnesses requiring specialist healthcare resources not always available at district-level government hospitals. The impact of this scheme was evaluated by a rapid assessment, commissioned by the government of Andhra Pradesh. The aim of the assessment was to explore the contribution of the scheme to the reduction of catastrophic health expenditure among the poor and to recommend ways by which delivery of the scheme could be improved. We report the findings of this assessment. Methods. Two types of data were used for the assessment. Patient data pertaining to 89 699 treatment requests approved by the scheme during its first 18 months were examined. Second, surveys of scheme beneficiaries and providers were undertaken in 6 randomly selected districts of Andhra Pradesh. Results. This novel scheme was beginning to reach the BPL households in the state and providing access to free secondary and tertiary healthcare to seriously ill poor people. Conclusion. An integrated model encompassing primary, secondary and tertiary care would be of greater benefit to families below the poverty line and more cost-effective for the government. There is considerable potential for the government to build on this successful start and to strengthen equity of access and the quality of care provided by the scheme.

Detection & characterization of Shiga toxin producing Escherichia coli (STEC) & enteropathogenic Escherichia coli (EPEC) in poultry birds with diarrhoea.

Background & objectives Limited information is available on shiga toxin producing Escherichia coli (STEC) in animals and birds from India. An outbreak of acute diarrhoea in poultry birds at Aizawl, Mizoram was investigated for detection and characterization of STEC and enteropathogenic E. coli (EPEC). Methods E. coli was isolated and identified from rectal swabs, intestinal contents, heart blood and spleen of 19 poultry birds that died due to acute diarrhoea during the outbreak. Phenotypic characterization was done by standard bacteriological and biochemical techniques. All the isolates were serotyped based on their somatic antigens. Virulence genes (stx1, stx2, eaeA and hlyA) were detected by multiplex PCR assay. Results A total of 42 E. coli isolates were obtained, of which 24 belonged to 3 serogroups (O64, O89 and O91) and the remaining 18 were untypable (UT). Altogether, 14 (33.33%) isolates carried at least 1 virulence gene, of which 10 (23.81%) and 4 (9.52%) were recorded as STEC and EPEC, respectively. Of the 10 STEC isolates, one carried only stx2, one carried stx2 and hlyA, four carried stx1, stx2 and hlyA, two carried stx1, eaeA and hlyA genes and two carried stx1 and eaeA. Of the four EPEC isolates, two carried eaeA and hlyA, one carried only eaeA gene and 1 carried only hlyA gene. Interpretation & conclusions This is the first report on the involvement of STEC in poultry in India.

Growth patterns of fossil vertebrates as deduced from bone microstructure: case studies from India.

Bone microstructure is affected by ontogeny, phylogeny, biomechanics and environments. These aspects of life history of an extinct animal, especially its growth patterns, may be assessed as fossil bone generally maintains its histological integrity. Recent studies on the bone histology of fossil vertebrates from India encompass different types of temnospondyls and dicynodonts from different Permian and Triassic horizons. The examined taxa show that they had distinct bone histology and varied growth patterns. The Early Triassic trematosaurids had an overall fast growth, which contrasts with that of the Middle and Late Triassic temnospondyl taxa examined. The dicynodonts on the other hand, were characterized by an overall fast growth with periodic interruptions, variable growth rates dependent on ontogeny and indeterminate growth strategy. A comparative study encompassing several neotherapsid genera including the dicynodonts shows signifi cant evolutionary trends towards determinate growth strategy and reduced developmental plasticity.

Bilateral benign non functional struma ovarii with Pseudo-Meigs' syndrome.

Bilateral presentation of benign Struma ovarii is rare and has not been reported frequently in published literature. A 70-year-old postmenopausal female presented with progressive ascites, bilateral pleural effusion and elevated CA-125 levels. The contrast-enhanced computed tomography (CECT) of the abdomen and pelvis revealed a heterogenous mass in the left adnexa. These findings were suspicious for an ovarian malignancy. After surgery the diagnosis of non functional, bilateral benign Struma ovarii was made. Struma ovarii is a specialized ovarian teratoma composed predominantly of mature thyroid tissue. It is associated with pleural effusion and ascites (Pseudo-Meigs' syndrome) in 5% of cases. The combination of struma ovarii and elevated CA-125 levels has been reported infrequently. This is a rare case of bilateral benign struma ovarii associated with Pseudo-Meigs' syndrome and elevated CA-125 levels. Surgical excision of the ovarian masses induced immediate resolution of the ascites and pleural effusion and a reduction of the serum CA-125 level.

Massive haemothorax: a presentation of pulmonary arteriovenous malformation.

Arteriovenous malformations of the lung are relatively uncommon lesions with varied clinical presentation. Nearly half of these are associated with Osler-Rendu-Weber disease. Magnetic resonance angiography is an accurate and non-invasive diagnostic modality. We report a case of a 56-year-old male who had massive haemothorax due to rupture of a pulmonary arteriovenous malformation arising from the right interlobar artery.

Foreign body in ENT--general practitioner's duty.

Foreign body in ENT region is an age-old problem. Introduction of foreign body in ear, nose and throat is specially seen in children. There are many types of foreign body seen in the ear, nose and throat. They can aspirate into larynx, trachea and bronchus. How to manage the removal of foreign body in ear, nose and throat had been discussed in a nutshell. General practitioners should be skilled enough to remove foreign body with their limited resources and they should know when to send the cases to an ENT specialist or to a hospital.

A cohort study of correlation between body mass index and age at menarche in healthy Bengali girls.

There are contradictory reports of lowering of age at menarche due to increasing body mass index (BMI) in the population. It is not known if a greater BMI at menarche is associated with a lower menarcheal age in healthy Bengali girls of normal nutrition. In this study the age at menarche was determined in 273 Bengali girls of middle income families. It was assessed whether BMI standard deviation scores (SDS) at menarche, BMI SDS at one year preceding menarche and BMI increments during that year were in correlation with age at menarche. The age of the girls with adequate nutrition was 8-16 years. They were examined for BMI, pubertal breast staging and age at menarche over a 4-year follow-up period. BMI SDS were calculated from National Center for Health Statistics (NCHS) normative data. The median age at menarche of 12.0 (range 10.0 - 16.0) years did not correlate with BMI SDS at menarche or BMI SDS at one year preceding menarche in this cohort. In univariate analysis, BMI increments for a given breast stage did not significantly lower the age at menarche. The change of BMI in the year preceding menarche did not correlate with age at menarche. The age at menarche in healthy Bengali girls of middle income families was similar to that of other Indian observations. There was no influence of BMI increments or that of BMI SDS prior to or at menarche on age at menarche.

Primary duodenal lymphoma producing obstructive jaundice.

Primary lymphoma of the duodenum presenting with obstructive jaundice is a rare entity. We report a case of primary non-Hodgkin's lymphoma of the duodenum producing obstructive jaundice in a middle aged lady, where the concentric thickening of the duodenal wall also gave rise to symptomatic partial high small bowel obstruction in due course. Guided aspiration and flowcytometry established a diagnosis of diffuse large B-cell lymphoma.

Rhabdomyosarcoma of nose and paranasal sinuses--a therapeutic challenge.

Rhabdomyosarcoma is a highly malignant tumour of striated muscle and it is the most common soft tissue sarcoma in the paediatric age group. It is very uncommon in the nose and paranasal sinuses. Pinkish nasal mass and recurrent epistaxis are the most common presenting symptoms. Histologically embryonal rhabdomyosarcoma is the most common variant. The present series deals with seven such cases of different histopathological types including the embryonal, botryoid, and alveolar varieties in the paediatric age group. Multimodal treatment including limited surgery followed by radiotherapy and chemotherapy resulted in survival ranging from 3 days to more than 3 years, which was also influenced by the severity of the disease at presentation and its aggressiveness.

Melnick- needles osteodysplasty presenting with quadriparesis.

Melnick-Needles syndrome or osteodysplasty, a monogenic heritable bone dysplasia, is characterized by a typical facies and characteristic radiological findings. Less than 70 well-documented cases have been reported in literature; most of them were sporadic. We report the first case from Eastern India in an adolescent male, who had cranio-vertebral junction anomalies and presented with spastic quadriparesis at the age of 13 years.

Mitochondrial hepatopathies.

Hepatocyte mitochondrion functions as a cause and as a target of liver injury. Since the mitochondria are under dual control of nuclear DNA and mitochondrial DNA (mtDNA), mutations in genes of both classes have been associated with inherited mitochondrial hepatopathies. Point mutations, deletions, insertions, rearrangements, DNA depletion--all have been identified. Many factors influence the prevalence of mitochondrial disorders, including the mutations rate, inheritance pattern, population structure, and the genetic background. In primary disorders, mitochondrial defect is the primary cause of liver disease often producing fatal hepatic failure in infancy or childhood. In secondary disorders, insult to mitochondria is caused by either a gene defect that affects non-mitochondrial proteins or by an exogenous injury to mitochondria. Diagnosis should be suspected in cases of liver disease with neuromuscular symptoms, multisystem involvement that cannot be explained by a single pathology or rapidly progressive liver failure in early childhood. Laboratory findings in the blood and urine show an altered redox status. Various antioxidants, vitamins, cofactors, and electron acceptors have been for proposed but none is effective. Presence of neuromuscular or extraintestinal involvement in primary disorder precludes the use of liver transplantation.

Deaf child--a general practitioner's responsibility.

The power of a child's speaking language never develops if he is deaf. Deafness persists if it is not detected early. Childhood deafness is either congenital or acquired. At birth, doctors or attendants can detect deafness by arousing the baby with sudden loud noise. At 4 months onwards mothers and doctors can detect deafness. The baby at this age can turn its head or eyes towards the source of the sound. By 12 months to 2 years of age it is very difficult to detect deafness. By the age of 3 years children again become co-operative and it becomes easier to detect deafness. Children should always be screened for deafness while being admitted to nursery classes. In school going age ie, 5 years onwards loss of tests can be employed to detect deafness. If a child is suspected be deaf, a general practitioner's responsibility is to refer him to an ENT specialist earlier. Any child whose mother believes her child is deaf should be given due attention. Otitis media with effusion, enlarged adenoid, chronic suppurative otitis media, recurrent otitis media are some diseases to be carefully looked into by the general practitioners. Now-a-days cochlear implantation surgery is gaining popularity to give hearing to deaf child. Moreover regular screening for deafness should be included school heath programme.