Mucormycosis - The black menace in COVID-19

The current outbreak of second wave of COVID-19 in India has seen the rise of opportunistic infections, a deadly one being mucormycosis or “black fungus.” As of now, there are over 9000 cases of this deadly disease which have been reported from several states in India. Nine states in India including Punjab, Uttar Pradesh, Rajasthan, and Bihar have declared mucormycosis as an epidemic. There are five types of mucormycosis – rhino-orbital-cerebral, pulmonary, gastrointestinal, cutaneous, and disseminated. Out of these, rhino-orbital-cerebral and pulmonary mucormycoses are most common in post-COVID patients. The clinical presentation of such patients include cough, fever, breathlessness, chest pain, sinusitis, pain on one side of the face with lack of sensation and proptosis of eye. Diagnosis could be done through analysis of clinical findings, direct microscopy, serum antigen tests, culture, histopathology, radio imaging, and polymerase chain reaction/ matrix?assisted laser desorption ionization time?of?flight. Treatment will include preventive measures taken at home or at hospital for post?COVID patients. Medical treatment of mucormycosis mainly includes installing a central catheter (line), maintaining adequate systemic hydration, and infusion of normal intravenous saline before antifungal amphotericin B infusion. Since amphotericin is nephrotoxic, alternative drugs, such as posaconazole or isavuconazole, can be suggested. Adjuvant therapy with caspofungin, deferasirox, statins, aspirin, and hyperbaric oxygen may have to be considered as well. Extensive surgical debridement can also be suggested to remove all necrotic tissues. This review emphasizes the different aspects of mucormycosis such as epidemiology, etiopathogenesis, risk factors, diagnosis, preventive measures, and treatment strategies that can be adopted to tackle this fungal menace in COVID-19.

FNAC as a diagnostic tool for Tuberculouslymphadentitis at peripheral health institutions

Background:Tuberculosis is a common and important public health problem in India. Fine Needle Aspiration Cytology (FNAC)is very easy, simple, quick,cheap and specific method for diagnosis of Tuberculous Lymphadenitis. The objective of this studywas to study the diagnostic yield of FNAC for diagnosis of Tuberculous Lymphadenitis by ZN staining and Cytopathologicalcharacteristics.Material and Methods: Present study was a retrospective study. FNAC/ aspiration was done in cases of superficiallymphnodes / abscess were analysed for diagnostic yield of Tuberculous etiology by ZN staining and cytopathologicalcharacteristics.Results: A total of 136 cases of superficial lymphadenitis presenting as solid swelling or abscess were subjected toFNAC examination. Smears were prepared from the aspirated material. Two separate slides prepared, stained with Giemsa and ZNstain. Total of 73 cases (53.67%) slides showed evidences suggestive of Tuberculous etiology out of which 33 (45.2%) were foundAFB positive on ZN stain. One AFB positive (not included as AFB positive in the analysis of results) slide was suggestive ofMycobact.leprae as confirmed by Fite stain.Conclusion: FNAC is a simple, safe, quick and cheap method to establish thediagnosis. Procedure is very safe, easy and can be performed by any doctor of PHI. Demonstration of AFB in the smear gives abacterilogically confirmed diagnosis very quickly. Cytological examination can further improve the diagnostic yield withoutbacteriological confirmation.

Antenatal and intra-natal care practices in urban slums of Lucknow City, UP.

Objectives: To study the Antenatal and Intra-Natal Care Practices in urban slums of Lucknow city, UP. Methods : A cross- sectional study in Urban slums of Lucknow city, UP included 524 women who had a live birth during last one year preceding data collection. The data was tabulated on Microsoft Excel sheet and analyzed using the software SPSS 10.0 for Windows. Results : Study findings showed that Majority (71%) of the mothers received ANC. Out of those who received ANC, 32.5 percent of them received 2 ANC and 25.3 percent received 3 ANC. The tetanus toxoid (TT) vaccination was received by 80.4 percent mothers. Out of those who received tetanus toxoid, 67.9 percent received two doses of tetanus toxoid and 18.7 percent one dose of tetanus toxoid. The study findings shows that about half (51.7%) of the deliveries took place at home followed by govt. health facility (28.4%). Only 19.8 percent of the deliveries took place at private health facility. Majority (73.4%) of the deliveries were conducted by trained birth attendant. Only 19.6 percent and 7 percent deliveries were conducted by relatives and untrained birth attendant respectively. Conclusion: In majority of cases correct Antenatal and Intra-natal care practices were lacking among mothers and this should be promoted through improved coverage with existing health services.

Acanthamoeba keratitis with Curvularia co-infection.

We report a case of Acanthamoeba keratitis with Curvularia co-infection. Acanthamoeba and fungal co-infection have been uncommonly reported in literature, worldwide. A classical history with a strong clinical suspicion and experienced laboratory personnel with systematic examination of corneal scrapings for bacterial, viral, parasitic and fungal causes are imperative for accurate diagnosis. Early diagnosis of Acanthamoeba keratitis or fungal infection followed by aggressive and appropriate treatment with effective agents is critical for the retention of good vision. Acanthamoeba keratitis is difficult to diagnose and, despite improvement in treatment options, may culminate in prolonged morbidity and significant loss of visual acuity. This case emphasizes the important role played by clinical microbiologists in making prompt diagnosis which can ultimately reduce visual morbidity.

A study of the pattern of head injury in District Aligarh. U.P.. India.

Trauma as a general rule carries medicolegal implication. Head injury adds complexity to the problem as it adversely affects the complete evaluation of trauma until some time has elapsed after a particular injury. The often ill-defined clinical manifestation, the impact of claim settlements, and malingering further add to the problem of fair decision.

Serodiagnosis of dengue during an outbreak at a tertiary care hospital in Delhi.

Dengue, an important human arboviral infection, is endemic in many parts of India. Outbreaks are now reported quite frequently from different parts of the country. We report here findings of serological investigation of serum samples received during a recent outbreak of dengue infection in Delhi from September to November 2003. Acute phase serum samples from suspected cases of dengue infection (including dengue fever, dengue haemorrhagic fever and dengue shock syndrome) of duration 5 days, were tested for dengue specific IgM antibodies by enzyme linked immuno sorbant assay (ELISA). Of the 874 serum samples tested, 456 (52.3% ) were positive for dengue specific IgM antibodies. The maximum number of positive cases was reported in October, peaking in second and third week. Patients in the age group of 21-30 yr accounted for 34.2 per cent of positive cases. This outbreak was less severe as compared to the previous 1996 outbreak and showed a shift towards an older age group.

Larvicidal activity of latex and stem bark of Euphorbia tirucalli plant on the mosquito Culex quinquefasciatus.

The methanolic, chloroform and ether extracts of Euphorbia tirucalli latex and stem bark were evaluated for larvicidal activity against laboratory-reared larvae of Culex quinquefasciatus (Diptera: Culicidae), vector of the brancroftian filariasis and worst urban nuisance mosquito. The latex extracts contain more potent larvicidal components (177.14 mg/L-326.37 mg/L) than the stem bark extracts (237.663 mg/L-513.39 mg/L). The order of toxicity (LC50) for the latex extracts was Methanol extract (177.14 mg/L) > Chloroform (200.76 mg/L) > Ether (326.37 mg/L) while the rank of order of toxicity (LC50) of stem bark extracts was Ether (237.66 mg/L) > Chloroform (343.515 mg/L) > Methanol (513.387 mg/L), Higher doses (LC90 24 h of mosquito larvae) of each extract did not cause any mortality among fishes after 24 h. The study gave a weight into the possibility of formulating suitable preparation from the latex and stem bark extracts of the plant for use in mosquito control programme.

Expression of adenosine deaminase and 5'-nucleotidase in artificially induced deciduoma in rat and hamster.

Enzymes adenosine deaminase (ADA) and 5-nucleotidase (5-'NT) are known to play active role in tissue/cell proliferation and differentiation. To validate this the two enzymes were studied in artificially induced deciduoma of rat and hamster. The deciduoma was induced by traumatizing one of the uterine horns of progesterone primed animals. Non traumatized horn served as control. The animals were later maintained on progesterone, given alone (Gr.I) or conjointly with estrogen (Gr.II). The weight of each uterine horn was recorded to determine the formation of deciduoma. There was no marked difference between the weights of traumatized and control horn on day 2 post-traumatization (PT), but a progressive rise was noticed after this day in both species. The ADA activity however differed, day and species wise. While in the rats of Gr.I it was low in the traumatized horn on all the days, in the hamsters it was remarkably high from day 2 to 6 PT. In the rats of Gr.II also the activity though was low in the traumatized horn, but on day 2 and 4 only; on day 6 and 7 PT it increased markedly. In hamster, on the contrary, again the enzyme activity was remarkably high on all the three days. The 5'-NT activity, however, did not show any marked difference between the two horns under Gr.I and II in both species. It was rather high in the control horn of each group. The results suggest: (I) the progesterone alone though produces a significant rise in the uterine weight of traumatized horn in both species, the ADA activity increases only in hamster, (2) under the conjoint treatment also the enzyme activity remains high in hamster; and (3) the activity of enzyme 5'-NT does not alter during the deciduoma formation in both the species.

Evaluation of analgesic, antipyretic and anti-inflammatory activity of spirobarbitunylphenothiazines in rodents.

Analgesic, antipyretic and anti-inflammatory activities of newly synthesized spirobarbitunylphenothiazines viz 10-[7, 11-Di(4-4' dimethoxphenyl)-3-oxo-9-methylaminoimino-2, 4-diazaspiro [5.5] undecane 1, 5 dione] acetylphenothiazine (test drug A) and 10-[7, 11-Di (N.N-dimethylaminophenyl)-3-oxo-9-methylaminoimino-2, 4-diazaspiro [5, 5] undecane-1, 5 dione] acetylphenothiazine (test drug B) have been screened in Swiss mice and Wistar rats. The peripheral analgesic activity of test drugs A and B was investigated by acetic acid induced writhing test in Swiss mice while the central analgesic action was assessed by hot-wire (tail flick test) of the analgesiometer and tail-clip test in Wistar rats. Antipyretic activity was assessed on Brewer's yeast induced pyrexic model while antiinflammatory activity was seen on carrageenan induced hind paw oedema. Analgesic activity was found to be only of peripheral type as there was reduction of 66% in writhing responses by test drugs A and B in dose of 80 mg/kg in mice. No change in the tail flick responses was observed on analgesiometer or by tail clip by both the test drugs. Reduction of 1.5 to 2.0 degrees C in rectal temperature was observed in pyretic rats by test drugs A and B in dose of 80 mg/kg. 80% reduction in paw volume was noted in 80 mg/kg dose of both the test drugs which was comparable to the anti-inflammatory activity of 300 mg/kg, p.o. of phenylbutazone.

A multicentric study with arteether in patients of uncomplicated falciparum malaria.

Two hundred and sixty seven patients of uncomplicated P. falciparum malaria completed study in a multicentric phase III clinical trial of Arteether. Arteether was given intramuscularly in a dose of 150 mg daily for three consecutive days. Each patient was followed upto 28 days of alpha, beta arteether therapy. The cure rate was 97% with fever clearance time between 1-7 days (24-168 hours) and parasite clearance time between 1-3 days (24-72 hours). Parasite reappearance rate was found to be 3% and reported at only three of the centres. Following the treatment no adverse effect was observed on haematological, biochemical and vital clinical parameters.

Detection of mycobacterial antigen in circulating immune complexes in patients with childhood tuberculosis.

The presence of both components (antigen and antibody) in circulating immune complexes (CIC) were detected in tuberculosis in children. Fifty two patients with pulmonary and extrapulmonary tuberculosis showed the presence of either components or both. CIC--antigen was present in 92.3% (48/52) and CIC antibody in 88.96% (46,52). Out of these 52 patients, 20 were proved cases, CIC antigen (ag) and CIC--antibody (ab) were present in 100% (20/20). In the control group both CIC-ag and CIC-ab and CIC = ab can be taken as an additional marker in diagnosis of tuberculosis.

Carcinoid tumor of common hepatic duct.

Primary carcinoid tumors of the biliary tract are extremely rare. We report a 36-year-old woman with recurrent acute cholangitis who was diagnosed to have a carcinoid in the common hepatic duct, with enlarged local nodes. She underwent local resection. I-131 metaiodobenzyl guanidine (MIBG) scanning postoperatively showed no uptake in the tumor bed.