Oral Rivaroxaban in the Prophylaxis of COVID-19 Induced Coagulopathy

Background: Preliminary data highlights the importance of anticoagulation therapy in the prevention and treatment of thromboembolism in SARS CoV-2 infection. There is insufficient data comparing the safety and efficacy of direct oral anticoagulants (DOACs) and subcutaneous enoxaparin in the prophylactic management of COVID-19 associated thromboembolic disease, particularly in mild to moderate cases of COVID-19 infection. Objectives: The study was designed to investigate the efficacy of oral rivaroxaban as a prophylactic anticoagulant in mild to moderate SARS CoV-2 infection. Methods: In this randomized, open-label, prospective superiority trial involving hospitalized patients with confirmed mild or moderate COVID-19 disease without known thromboembolism, we assigned 230 patients to receive either once-daily oral rivaroxaban (10mg or 15mg) or once-daily subcutaneous enoxaparin (40mg or 60mg) for a median duration of 8 days. The primary outcome was a composite of all major, clinically relevant haemorrhagic and thrombotic events. Results: The primary efficacy outcome occurred in 4 of 115 patients in the rivaroxaban group (3.5%) versus 16 of 113 patients in the enoxaparin group (14.2%) (hazard ratio 0.207, 95% confidence interval [CI], 0.069 to 0.621, P=0.005). Adverse events developed in 4.3% of patients in the study group and 12.4% in the enoxaparin group (hazard ratio 0.328; 95% CI, 0.118 to 0.910; P=0.032). Major bleeding was seen in 1 patient (0.9%) in the rivaroxaban group and 3 patients (2.7%) in the enoxaparin group. Conclusions: Rivaroxaban alone was superior to enoxaparin for the prophylactic management of coagulopathy associated with mild to moderate SARS CoV-2 infection.

Evaluation of Bilateral Ureteral Urinary Jet Flows for Patency of Uretero- Vesical Junctions by Color Flow Imaging

Background: Ureters are meant to transport urine from the pelvis to the urinary bladder in the form of urinary jet. This is continuous process with intermittent release of urine at uretero-vesical junction. This is regulated by autonomous nervous system. The urine coming to urinary bladder can be seen by color flow imaging (CFI) .This also reflects the patency of the ureter without any obstruction in the pathway. Methods: The size of the population was 30 patients (20 males and 10 females). In this study, the Color Doppler ultrasound was used to evaluate the ureteral jets flow in 10 healthy patients and 20 patients with obstructive uropathy. A probability sampling method was employed while collecting samples. Results: In the right ureteral-vesical junction there was complete absence of detectable jets in 5 patients, 6 patients had weak flow of jet and 19 patients had normal flow of jet. Similarly, in the left ureteral-vesical junction there was complete absence of detectable jet in 3 patients, 12 patients had weak flow and 15 patients had normal flow. Conclusions: The color Doppler evaluation of the ureteral jets is a valid method of evaluating ureteral and renal calculi obstruction and could be a first line of investigation to detect ureteric obstruction in patients with obstructive uropathy.

An Unusual Presentation Of Oral Myiasis In Maxilla: A Case Report

Myiasis is a universal term for infection by the parasitic fly larvae that feed on their host, which can be either living or dead tissue. Oral myiasis is still “rare” and “unique” due to the fact that oral cavity rarely provides the necessary habitat conducive for a larval lifecycle. In humans, the most commonly affected sites are the nose, eyes, skin wounds, sinuses, lungs, ears, gut, gallbladder, vagina, nasal cavities, and rarely the mouth. Here, we report a case of oral myiasis in an 83-year-old female patient reporting with swelling in the maxillary anterior region with the movement of bugs inside the mouth since 2–3 days. Treatment of myiasis has been discussed in the case report.

Role of Wnt-p53-Nox Signaling Pathway in Cancer Development and Progression.

Signaling pathways play an intricate role in regulating the homeostasis of a normal cell and any chronically altered activity in such signaling pathways causes cancer. Such aberrantly activated Wnt and vanished p53 signaling contribute to the development of various carcinomas. Majority of cancer cells exhibit elevated production of reactive oxygen species (ROS) in an NADPH oxidases dependent manner that further enhances cellular damage. However, Nox family enzymes regulate various physiological functions; for instance, gene regulation, cellular signaling, host defense and cell differentiation. All of these processes get affected in cancer thereby signifying the role of Nox in controlling various signaling pathways such as Wnt and p53. Therefore, unraveling of complex signaling pathways underlying tumorigenesis is enforcing the development of next-generation anticancer drugs directed against specific molecular targets. This review provides an insight about Nox in regulation of Wnt and p53 pathway to govern the pathogenesis of cancer. Therefore, implementation of NOX inhibitors for inhibiting aberrant Wnt and p53 signaling could provide novel opportunities for therapeutic intervention.

A retrospective study of intravenous sodium stibogluconate alone and in combinations with allopurinol, rifampicin, and an immunomodulator in the treatment of Indian post-kala-azar dermal leishmaniasis.

Background and Aims: A retrospective analysis of treatment outcome using recommended dose of sodium stibogluconate (SSG) alone and in combination with other antileishmanial drugs in adults with post-kala-azar dermal leishmaniasis (PKDL) attending as outpatients. Methods: A total of 61 patients seen over ten years were included in the report. All had polymorphic lesions. Diagnosis was based on clinical picture, hailing from kala-azar (KA) endemic area, exclusion of other dermatoses, histopathology, and therapeutic response. Patients were distributed into two groups: Group I (n = 32), where SSG was given intravenously; in Group II (n = 29), they were allocated to one of four categories using SSG in combination with other drugs. In the first category, SSG was given along with allopurinol (n = 10); in second with rifampicin (n = 6); and in third with both allopurinol and rifampicin (n = 5). In the fourth category, SSG was administered with an immunomodulator (n = 8), Mw vaccine, known to enhance host Th1 response. Results: Only 12 out of 61 patients completed treatment till histopathologic evidence of cure, five in Group I and seven in Group II, no patient being from third category. None had taken SSG without interruptions. Time taken for papulonodules to subside was similar in both groups, but erythema and induration subsided earlier in Group II. Group I patients attained cure after 120 injections while in Group II it took 95 injections in SSG + allopurinol and Mw vaccine categories respectively, and 110 with SSG + rifampicin. Nevertheless this was insufficient to facilitate compliance. Poor performance and high dropouts related to long duration of therapy, thrombophlebitis, difficulty in accessing veins, disabling rheumatic side-effects and practical problems. Liver, renal and pancreatic functions and ECG remained normal. Conclusion: No major advantage was obtained using allopurinol, rifampicin or Mw vaccine along with SSG as compared to SSG alone.