Mucormycosis an Emerging Fungal Infection Associated with COVID-19- A Case Report

Introduction: Mucormycosis is an exceptional but rising fungal infection correlated with the COVID-19 disease. COVID-19 positive patients exhibiting severe symptoms admitted in the ICU have an increased susceptibility to develop bacterial and fungal infection. We hereby report a case of oral mucormycosis that is seen in a patient in post COVID-19 infection. Case Presentation: A 65-year-old woman presented to our institution, with the chief complaint of ulceration in her right palate region for the past 7 days along with pyrexia and generalised malaise. The patient reported to have recovered from COVID-19 infection recently. She presented with medical history of diabetes and hypertension for past 8 years. Post recovery from COVID-19 infection the patient developed an ulcer in the hard palate. Treatment: Surgery was done under General anesthesia. Maxillectomy was done with aggressive debridement of necrotic tissue. Bilaterally periosteal flap was approximated and suture was placed. Conclusion: The extensive use of steroids and broad-spectrum antibiotics in COVID-19 treatment may raise the risk of fungal infections. Medical practitioners should be aware of the possibility of invasive secondary fungal infections in patients with COVID-19 infection.

Are Parents Willing to Vaccinate Their 6- To 11-Year-Old Children Against COVID-19? A Community Based Study in Murshidabad, India

Context/Background: The future of Corona virus disease is still uncertain due to viral mutations. Immuniza-tion against COVID-19 has not yet been introduced for children aged 6-11 years. Parents are instrumental for the success of any immunization programme, being the chief decision makers for their wards. The study aims to assess the perceptions of parents regarding COVID 19 vaccination among children aged 6-11 years in an urban slum of Murshidabad and identify the factors influencing such perceptions among them. Methodology: A cross sectional study was conducted among 106 parents in a slum area of Murshidabad, West Bengal. Participants were interviewed using a validated WHO Vaccine Hesitancy Scale (VHS). Bivariate and multivariable analysis were done using Chi square test and binary logistic regression respectively. Results: Majority of the study subjects instead of parents were unlikely to vaccinate their children against COVID-19. The major concern centered around the safety (73.5%) of the vaccine. Higher level of education (p=0.003), previous history of COVID-19 infection in the family (p=0.004) and having a children aged between 6-8 years (p=0.006), influenced such perceptions, with the latter being the single most important predictor (AOR 4.126, P=0.007). Conclusions: The likelihood of parents to vaccinate their child was found to be low. This underscores the im-portance of an effective communication strategy when such programme will be rolled out.

Kaposiform hemangioendothelioma in an unusual site: A report of two cases in children

Kaposiform hemangioendothelioma (KHE) is a locally aggressive vascular tumor usually seen in children. It is frequently associated with Kasabach-Merritt phenomenon. Here we report two cases of KHE: the first case being an 11-month-old boy who came with massive swelling on the face and violaceous discoloration. The second case was a 7-year-old boy who presented with respiratory distress and bleeding manifestations. CT scan chest showed a large mass involving the anterior mediastinum. Histologic examination of resected masses from both these cases showed features of KHE involving subcutaneous tissue and thymus, respectively. Although cutaneous and subcutaneous location is common, thymic involvement is unusual. It is important to distinguish KHE from infantile haemangioma, tufted angioma, spindle-cell haemangioma, verrucous malformation and Kaposi sarcoma. Histologic features, supportive immunohistochemistry and the clinical profile together are helpful to differentiate KHE from other vascular lesions.

Spinal anesthesia during cesarean section and persisting low back pain: a cross sectional study in West Bengal, India

Background: Spinal anesthesia related spinal injury can be a major issue in elevating back pain. Several evidences have established this process as a significant contributor of back pain; though contradictions are also present. This study aims to focus on the consequences of back pain associated with the effects of spinal anesthesia that have been received before several years. Methodology: 48 housewives are included in this study (20 subjects for vaginal delivery and 28 subjects for spinal anaesthesia induced cesarean section) based on convenient sampling method through assessing their socio-economic status and other attributing criteria. Pain detect tool was used to track back pain status and a semi structure questionnaire was used to explore other considerations. Results: Results have shown significant differences in pain responses after receiving spinal anesthesia (exposed group) than control group. Subjects have reflected significant differences in their pain perception scores. Conclusion: This study concludes that subjects have shown significant higher pain perception levels after receiving spinal anesthesia compared to general anesthesia. Decision of Cesarean section delivery should include patient’s previous pain conditions and current need. Acute care in post surgical pain should be immediately addressed even after several months of the surgery.

Clinical Profile of Co-Infections and Bacterimia in Adults with Malaria – An Experience from a Tertiary Care Hospital in Northeastern India.

Bacterial co-infection associated with malaria is potentially important but poorly documented. Published reports are mainly from African children while data from adult Indian population are limited. To determine the spectrum of concurrent bacterial infection in malaria the present study was conducted in department of Medicine at Tripura Medical College. Out of eighty patients, 58 had falciparum, 15 had dual infection and 7 had vivax malaria. Blood culture failed to confirm bacteraemia in any sample with the exception of one case of complicated malaria showing the growth of Escherichia Coli. Urine culture also grew Escherichia Coli in 2.5% of enrolled patients. Anti salmonella IgM antibody was detected in 7.5% of the study population. Sputum culture was positive of streptococcus pneumoniae in single patient with radiological evidence of consolidation. CSF culture was sterile in cases with cerebral malaria. Thus the present study shows that bacteraemia is uncommon in adults with malaria compared to children of endemic areas. Presence of other co-existent infections should be sought in clinically suspected cases only. We propose a restrictive antibiotic policy in the setting of malaria.

YnfA , a SMR family efflux pump is abundant in Escherichia coli isolates from urinary infection.

A quantitative study was undertaken to determine the expression level of different effl ux pumps in multi-drug-resistant (MDR) Escherichia coli isolates from urinary infection. We have determined the presence of different effl ux pumps and measured the expression level of tolC, mdfA, norE and ynfA genes among 48 isolates by quantitative real-time PCR. The expression level of tolC and ynfA was constantly high and observed among 75-80% of isolates, whereas mdfA and norE were expressed occasionally. Our fi ndings suggest that ynfA, a new SMR effl ux pump gene family member increases the antibiotics’ resistance in E. coli.

A Study of Cerebro Vascular Accident Patients.

To find out the proportion of different types of strokes among the CVA patients and to examine the correlation between stroke and various risk factors. Patients and Methods: Sixty CVA patients who attended the department of Medicine of TMC & Dr.BRAM Teaching hospital comprised the material for this study. Detailed history, clinical examination especially CNS examination, different biochemical and radiological investigations including CT Scan were performed to establish the diagnosis of CVA and to confirm the type of CVA. Various risk factors then correlated in causation of CVA. Result: Out of 60 CVA patients 42(70%) had ishaemic and 18(30%) had haemorrhagic stroke. Among the 42 ischaemic stroke patients 12 (20%) had lacunar stroke. 38 patients (63.3%) had hypertension, out of which only 4 (15%) had regular follow up showing that hypertension is a definite risk factor. Serum Cholesterol (213.52 ± 32.97) and Serum Triglyceride (176.25 ± 41.97 ) were statistically significant (p<0.01) along with Serum LDL (117.88 ± 27.18) and VLDL (49.11 ± 13.76),t value 5.096 and 5.128 respectively. In this study 14 (23.3%) patients had diabetes mellitus, 31 (51.6%) smokers, 14 (23.3%) alcoholics and 15 (25%) overweight, but none of them could be established as a statistically significant risk factor.

Dark after cholecystectomy.

We report a patient who complained of becoming darker after an abdominal surgery. The index patient not only had a darker complexion after cholecystectomy, but his glycaemic control was also getting better after operation to the extent that he could stop insulin, which he had been taking for five years. Also, he had lost significant weight after operation. Later, we found that he had developed primary hypocortisolism due to unrecognized bilateral adrenal haemorrhage in the immediate postoperative period.

Primary orbital lymphoma.

Primary orbital lymphoma is a rare condition involving primarily the lacrimal glands. We present the second Indian case of right-sided primary orbital lymphoma in an elderly male who presented with the typical features and showed a good response to chemotherapy.

Hypertension in elderly--an overview.

Hypertension (HT) is a common disease in elderly. It has different pathophysiologic, clinical and therapeutic implications in this age group. Due to loss of arterial wall elasticity with age, major vessels including aorta become stiff and less distensible. As age advances, these stiff vessels also lose beta adrenergic responsiveness with unchanged alpha adrenergic responsiveness. These together raise peripheral vascular resistance and aortic impedance which needs a powerful systolic ejection of left ventricle to maintain cardiac output. Result is rise in systolic blood pressure (SBP) and increase in left ventricular (LV) mass with compromised cardiac output and renal blood flow. Participation of renin-angiotensin system and kidney in HT pathogenesis in elderly are minimum. Diagnosis of HT in elderly is made if SBP > 140 mm Hg and/or diastolic blood pressure (DBP) > 90 mm Hg or is taking antihypertensive medications. Isolated systolic hypertension (ISH) means SBP > 140 mm Hg with DBP < 90 mm Hg. Measurement of blood pressure (BP) is problematic, mainly due to pseudo HT, postural hypotension and white-coat HT. HT in absence of end organ changes suggest pseudo HT. Postural hypotension must be detected and treated. Systolodiastolic HT, carried over from middle age is the commonest type of HT in elderly. ISH is also common (10%). Atherosclerotic renovascular disease can cause secondary HT. Therapy is always needed in HT in elderly. Chance of coronary artery disease (CAD) and cerebrovascular accident (CVA) are quite high amongst elderly hypertensives. SBP is more dangerous than DBP. Benefits of therapy are more when compared to young. HT should be treated if SBP > 160 mm Hg and/or DBP > 90 mm Hg. ISH needs therapy if SBP > 160 mm Hg. The benefits of therapy becomes less after 80 years. Treatment goal should be to keep BP below 140/90 mm Hg. Therapy should be gradual and stepwise. Na-restriction should be modest. Diuretics (e.g., thiazide 25 mg/day) are the drug of choice unless contra-indicated. Beta blockers are inferior agents compared to diuretics unless angina or acute myocardial infarction (AMI) is present. Angiotensin converting enzyme (ACE) inhibitors are drug of choice only if congestive cardiac failure (CCF) and/or diabetes is present or other drugs are contra-indicated. Calcium entry blockers (CEB) are new but very good alternative to diuretics in elderly. Due to abnormal physiology, pharmacokinetics and drug interactions, side-effects are very common in elderly. They should be detected early and treated.