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Background: Cutaneous mucormycosis has shown a significant upsurge during the COVID-19 pandemic. Due to the rapid progression and high mortality of cutaneous mucormycosis in this context, it is important to identify it early. However, very few studies report detailed clinical descriptions of cutaneous mucormycosis in COVID-19 patients. Objectives: To describe mucocutaneous lesions of COVID-19-associated mucormycosis based on clinical morphology and attempt to correlate them with radiological changes. Methods: A retrospective cross-sectional study was conducted at a tertiary care centre from 1st April to 31st July 2021. Eligibility criteria included hospitalised adult patients of COVID-19-associated mucormycosis with mucocutaneous lesions. Results: All subjects were recently recovering COVID-19 patients diagnosed with cutaneous mucormycosis. One of fifty-three (2%) patients had primary cutaneous mucormycosis, and all of the rest had secondary cutaneous mucormycosis. Secondary cutaneous mucormycosis lesions presented as cutaneous-abscess in 25/52 (48%), nodulo-pustular lesions in 1/52 (2%), necrotic eschar in 1/52 (2%) and ulcero-necrotic in 1/52 (2%). Mucosal lesions were of three broad sub-types: ulcero-necrotic in 1/52 (2%), pustular in 2/52 (4%) and plaques in 1/52 (2%). Twenty out of fifty-two patients (38%) presented with simultaneous mucosal and cutaneous lesions belonging to the above categories. Magnetic resonance imaging of the face showed variable features of cutaneous and subcutaneous tissue involvement, viz. peripherally enhancing collection in the abscess group, “dot in circle sign” and heterogeneous contrast enhancement in the nodulo-pustular group; and fat stranding with infiltration of subcutaneous tissue in cases with necrotic eschar and ulcero-necrotic lesions. Limitations: The morphological variety of cutaneous mucormycosis patients in a single-centre study like ours might not be very precise. Thus, there is a need to conduct multi-centric prospective studies with larger sample sizes in the future to substantiate our morphological and radiological findings. Conclusions: COVID-19-associated mucormycosis patients in our study presented with a few specific types of mucocutaneous manifestations, with distinct magnetic resonance imaging findings. If corroborated by larger studies, these observations would be helpful in the early diagnosis of this serious illness.
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Background: Cementation of prosthesis achieves a good initial fix in an osteoporotic bone, however, arthroplasty using a cemented implant may be associated with increased mortality compared with an arthroplasty using an uncemented implant, as it has the risk of bone marrow and fat embolization with resulting intraoperative hypotension and increased incidence of deep vein thrombosis. This aim of the study wasto evaluate the complications, morbidity, and mortality rates associated with each of the procedures and study the radiographic changes, recovery to physical independence and advantages encountered in each of the procedures, and achieve stable fixation and early mobilization. Methods: Pre-operative and a postoperative assessment was done on patients who underwent Cemented and Uncemented for femoral neck fractures. After the procedure, the frequent follow-up was carried out. Clinical evaluation was done for limblength discrepancy, thigh pain, rotation of the limb, gait pattern, and range of movements.Results:The incidence of postoperative complications was higher in the uncemented group than in the cemented group. The cemented group showed significantly betterresults than the uncemented group regarding walking distance. There was a statistically significant difference between the two groups regarding Harris hip score.Conclusions: For elderly patients with a displaced femoral neck fracture a cemented hemiarthroplasty is favorable compared to an uncemented stem. There was no significant overall difference in mortality rate, cardiovascular and cerebrovascular complications, general complications, local complications, and reoperation rate.
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Background: Sepsis is still one of the most leading cause of death in world. 19 million sepsis (formerly severe sepsis) cases and 5 million sepsis-related deaths are estimated to occur annually. Sepsis is also one of the most common cause of patients getting critically ill and getting admission in intensive care unit. The main focus of this study is to identify the culture isolate from the critically ill patients and to check for the antibiotic sensitivity and resistance and identify if the report has changed the course of treatment and outcome of the patients. Critical illness is a life-threatening multisystem process that can result in significant morbidity or mortality. Critically ill patients are those who have dysfunction or failure of one or more organs/system and depend on survival from advanced instruments of monitoring and therapy. The aim of the study was to identify the causative organism causing sepsis in critically ill patients.Methods: It will be multi central retrospective study which included patients of critical illness of Rohilkhand Medical college, Bareilly, Uttar Pradesh and Varun Arjun Medical college, Shahjanpur, A total of 468 patients were taken for the analysis during period of from August 2018 to November 2019 among of which 324 samples came positive. Samples were taken on day one of the patient’s presentation to the hospital and were analysed in BD BACTEC culture medium. Patient’s data were taken from records available at both the hospitals. Sensitivity was performed using disk diffusion method and the results were compared with the records of patients.Results: Among of samples taken that is 324; 194 were male and 130 were female. Maximum patients which were tested positive for Staphylococcus aureus (n=198). Others included Streptococcus pneumococcus (n=25), Escherichia coli (n=50), Klebsiella oxytoca (n=13), Klebsiella pneumoniae (n=15), Pseudomonas aeruginosa (n=20), and Acinetobacter (n=3). In retrospective analysis of the patients of all 324 cases treatment in approximately 148 patients was changed due to change in the sensitivity of antibiotics.Conclusions: Staphylococcus still dominates the sepsis. It is advisable to add an antibiotic with gram negative if patients count does not improve in first 24 hour.
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Background: Malnutrition in the primary school children is one of important problems in India with long term ramifications. This may be related to faulty dietary habits, socioeconomic condition of the family etc. Malnutrition especially undernourishment can lead to delay in growth and development. Anthropometric assessment of the school children provides the information regarding the nutritional status. The objectives of the study were to find out the prevalence of undernourishment, overweight and obesity in the primary school children of the rural field practice area; to find out the association of socio-demographic variables with nutritional status.Methods: Cross sectional study was conducted from November 2013- February 2014 to assess the nutritional status of the primary school children of the rural field practice areas of our institution in Thumbay region of Dakshina Kannada.Results: The prevalence of undernourishment (thinness and severe thinness) and overweight and obesity was found to be 40.5%, 2.8% and 1.3% respectively. It was also found that significantly higher proportion of male students was having severe thinness compared to females.Conclusions: The present study showed that undernourishment (thinness) was still a problem in the rural area school children.
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Abscess is an accumulation of pus in tissue and it is caused by suppuration deep within a tissue, an organ or confined space. Though the bacterial profile from pus samples remains almost similar in various studies, the irrational use of antibiotics has lead to the emergence of various drug resistant pathogens. In this retrospective study we have taken 290 aspirated pus samples for aerobic culture and sensitivity and found 23 different aerobic bacterial isolates. Most common isolate was Escherichia coli (n-12) followed by Staphylococcus aureus (n-8) and one each was Acinetobacter spp., Klebsiella pneumoniae and Streptococcus spp. Sensitivity of E coli was found to be low for ciprofloxacin, amoxycillin+clavulanic acid, ceftazidime, cefepime and aztreonam; while sensitivity was high for amikacin, imipenem, colistin and tigecycline. Staphylococcus aureus was highly sensitive to most of the antibiotics that had been put for sensitivity testing. A continuous inspection should be carried out to monitor the antimicrobial susceptibility of bacterial isolates from aspirated pus samples to choose appropriate antibiotics for prophylaxis and treatment of infections.
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Background: Due to the injudicious and indiscriminate use of Anti-Microbial Agents (AMAs) among hospitalized patients especially in ICUs, it is extremely imperative to monitor and refine the prescribing pattern of antibiotics regularly. Hence an effective surveillance team consisting of a physician, a pharmacologist and a microbiologist should develop and implement an antimicrobial stewardship program based on the local antibiogam to increase the therapeutic benefits and curb the menace of Anti-Microbial Resistance (AMR). Aims:-To study the prescribing pattern of Anti-Microbial Agents and to evaluate the antimicrobial sensitivity pattern of common bacterial isolates in Medical ICU (MICU) of a tertiary care hospital. Methods: After taking approval from the Institutional ethical committee, this prospective observational study was conducted in the department of Pharmacology and Microbiology over a period of six months. Patient records were reviewed and analyzed to assess the prescribing pattern of antibiotics and Culture-sensitivity reports of various specimen from MICU were collected to determine the antibiotic sensitivity pattern. Results: Ceftriaxone (26%) was the most commonly prescribed drug followed by Metronidazole (16%). Fixed drug combinations such as Piperacillin+Tazobactam (14%), Amoxicillin + clavulanic acid (10%) and Cefoperazone + Sulbactam (8%) were also frequently used. The most predominant organism isolated was Klebseilla species (25%) followed by Acenitobacter species (19.4%). Colistin /Imipenem and Vancomycin/Linezolid depicted100% sensitivity for Gram-Negative (GNIs) and Gram-Positive Isolates (GPIs) respectively. Conclusions: The need of the hour is to preserve the power of the almost exhausted antimicrobial armamentarium against the rampantly emerging multidrug resistant organisms.
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Background: Infectious keratitis is a major cause of avoidable blindness worldwide. Fungus is an important aetiological agent of infectious keratitis following corneal trauma with vegetative matter. This infection should be promptly treated to limit the morbidity and dangerous sequelae. The purpose of this study was to detect causative agents from corneal scrapings and to identify the predisposing factors of mycotic keratitis. Methods: Corneal scrapings were taken in full aseptic precautions in total 112 suspected patients for fungal etiology and were subjected to direct examination by 10% KOH mount, gram stain and culture. Results: A total 112 cases of suspected corneal ulcers were subjected to KOH mount to detect fungal elements in corneal scraping and culture to isolate aetiological agents. In our study 29 (25.8%) samples were found positive in KOH mount and fungus was isolated from the all KOH positive samples. Males were more commonly affected and were mostly in the age group of 30-50 years. Fusarium species was the most common fungus isolated followed by Aspergillus species. Conclusion: Mycotic keratitis is a serious problem usually following corneal trauma, it requires rapid detection and identification of fugal agents for treatment to prevent disastrous consequences.
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Congenital epulis (CE) or “Granular cell epulis” also previously termed as “Neumann’s tumor” is a benign growth arising from the mucosa of the gingiva, typically seen as a mass protruding from the infant’s mouth, often interfering with respiration and feeding. These tumors generally present as a single mass arising from the upper alveolus. We report a rare case of two congenital epulides arising from the maxillary and mandibular alveolus in a day old female infant, which was surgically excised, allowing for early initiation of breast feeding. The tumor cells stained negative for S100 protein hence differentiating from other granular cell tumors. The clinical presentation, differential diagnosis in regard to the various neonatal oral swellings and the management of CE has been discussed.
Subject(s)
Gingival Neoplasms/congenital , Gingival Neoplasms/diagnosis , Gingival Neoplasms/therapy , Granuloma, Giant Cell/congenital , Granuloma, Giant Cell/diagnosis , Granuloma, Giant Cell/therapy , Humans , InfantABSTRACT
Propósitos: los procedimientos de intervención coronaria percutánea (ICP) y la ablación con catéter son intervenciones terapéuticas bien aceptadas para el tratamiento de las coronariopatías y de la fibrilación auricular (FA), respectivamente. La intención de los autores fue examinar las tendencias temporales en la prestación de estos servicios en la última década en Australia. Métodos y resultados: la revisión retrospectiva de las cifras de las ICPs y las ablaciones en casos de FA desde 2000/01 a 2009/10 se hizo con base en información proveniente de tres fuentes: el Instituto Australiano de Salud, Bienestar y Tercera Edad (AIHW), la base de datos de Medicare Australia (MA), y los registros locales de un centro de referencia terciario de alto volumen (RMH) para ablación de la FA. Se ajustaron modelos de regresión lineal comparando las tendencias en número de procedimientos ajustados para la población en el curso de un período de diez años. Hubo un incremento de 5%/año ajustado para la población en los ICPs en el curso de diez años, tanto de la fuente de AIHW como de MA respectivamente (p<0,001). Esto fue similar a la tasa de crecimiento de todos los procedimientos cardiovasculares (AIHW: 5,1 versus 3,8%/año, p=0,27). Las ablaciones por FA mostraron un incremento de 30,9%, 23,2% y 39,8% por año ajustado para la población en el curso de diez años de las fuentes AIHW, MA, y RMH respectivamente (p<0,001 para todos). El crecimiento de las ablaciones por FA fue significativamente mayor que el de las ICPs (p<0,001 para las fuentes de AIHW y MA) y todos los procedimientos cardiovasculares (AIHW: 30,9%/año versus 3,8%/año, p<0,001). Conclusión: la realización de servicios de ablación con catéter en caso de FA en Australia ha aumentado de forma exponencial en el curso de la última década. Su tasa de crecimiento anual supera la de las ICPs y todos los procedimientos cardiovasculares. Dada la epidemia creciente de FA, estos datos tienen implicancias cruciales para las políticas de salud pública que evalúan la idoneidad de la infraestructura, la capacitación y la financiación de los servicios de ablación de la FA.
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Dermatophyte with the ability to digest keratine invade and therve on keratinized of human and animals. In the present study, the activity of essential oil of Psidium guajava (Linn.) was evaluated against four selected dermatophytes, namely Microsporiumcanis, Trichophytomruburum, T. verrucossum, T. tonsurans. Dermatophyteswere isolated with the infected skin, scalp, nail and genital organs of patients from districts hospital, Bareilly. Griseofulvin was used as a standard antifungal drug against the test dermatophytes. Oil was extracted through clevenger’s apparatus. Maximum inhibition zone was reported 69 mm against T. verrucossum followed by 60 mm Trichophytomruburum, 48 mm Trichophytomruburum and 45mm Microsporiumcanis. All five concentrations of oil showed excellent inhibitory effect against all test dermatophytes as compared to standard antifungal used.
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Postoperative necrotizing scleritis should be considered in cases of persistent localized postoperative inflammation following all forms of surgical trauma. We present the history, clinical findings, and follow-up data of four patients with postoperative necrotizing scleritis. The clinical records of four patients who developed scleritis following ocular surgery were retrospectively reviewed. The first step in managing necrotizing scleritis is to rule out infectious etiology. Surgically induced necrotizing scleritis is an immune-mediated condition that can coexist with concomitant infectious condition, i.e. endophthalmitis, but response to imrnunosuppression leads to resolution of the disease and verifi es the diagnosis
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Purpose: To study the clinical profile of serpiginous choroiditis in eastern India. Materials and Methods: Ninety‑one eyes of 54 patients with serpiginous choroiditis presenting to a tertiary care centre in eastern India between January 2006 and December 2010 were included in the study. Clinical presentation, treatment given, and visual outcome of the eyes were studied. Results: Thirty‑five (64.8%) patients were male and 19 (35.2%) were female in the age group of 13‑62 years (mean age: 34.1 ± 18.7 years). Blurring of vision (71; 78%) and floaters (36; 39.5%) were commonest symptoms. In 75 (82.4%) eyes, choroiditis started from optic nerve head and spreading centrifugally. Overall, 38 (41.75%) eyes had macular involvement at first visit. Mantoux test reading was 10 mm or more (Group A) in 12 (22.22%) patients and less than 10 mm (Group B) in 42 (77.77%) patients. Difference between Groups A and B in macular involvement at first visit (10; 50% vs. 28; 39.4%) and rate of recurrence (3; 15% vs. 14; 19.7%) was not statistically significant (P = 0.37 and 0.68). Oral steroid (51; 94.4%) was the commonest mode of treatment. Fifty‑one (56%) eyes had two lines or more improvement in vision. Conclusions: The present study details the clinical presentation, treatment, and visual outcome of serpiginous choroiditis. Mantoux test reading does not affect the clinical presentation or the treatment outcome in these eyes.
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Temperature is a crucial determinant of biogeography, directly affecting the behavioral responses of the organisms. An acute static bioassay was conducted to evaluate the effect of temperature on dimethoate toxicity in a freshwater mussel Lamellidens marginalis. The mussel, were exposed for 96 hr at different concentrations of dimethoate (155.00, 160.00, 165.00, 170.00, 175.00, 180.00, 185.00, 190.00, 195.00, and 200.00 mgl-1) in the month of January when water temperature was 14.9±1.20C and at concentration 35.00, 37.00, 39.00, 41.00, 43.00, 45.00, 47.00, and 49.00 mgl-1 in the month of August when the water temperature was 28.0±0.50C. The LC50 values were calculated from the mortality data obtained (using EPA-Probit analysis version 1.5, statistical software). The 96 hr LC50 value recorded at higher temperature was 36.34mgl-1 and at low temperature was 163.59 mgl-1. The mussel exposed at higher temperature showed more sensitive behavioral responses like huge mucus secretion, sudden closure of shell valves, quick post-mortem changes and increased oxygen consumption in comparison to exposure at low temperature. Therefore, the increasing threat of global warming increases the risk of pesticide toxicity in the exposed organisms.
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An 11-month-old boy presented with focal seizures, myoclonic jerks and altered sensorium of one month duration, with a history of measles at eight months of age. A diagnosis of Subacute sclerosing panencephalitis (SSPE) was made on the basis of typical EEG changes and presence of anti-measles antibody in cerebrospinal fluid. A differential diagnosis of SSPE should be considered in all forms of acute encephalopathy in infants for early diagnosis and management.
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Chloroquine retinopathy is a known complication of long-term use of chloroquine. This retinopathy can appear even after usage of chloroquine has stopped. The present case report describes the history and clinical features of chloroquine retinopathy developing a decade after discontinuing the drug