A retrospective clinicopathological analysis of rhino-orbital mucormycosis in second wave of COVID-19

Background: During the present surge of COVID-19 positive cases, concurrent multifold increase in the incidence of mucormycosis cases has resulted into significant morbidity and mortality. We retrospectively evaluated the clinicopathological features along with microbiological examination findings in histologically diagnosed cases of rhino-orbital mucormycosis. Material and Methods: All the H and E and special stained slides of included mucormycosis cases were retrieved from the records and were evaluated with microbiological findings including screening KOH mount examination and culture results. Results: Out of 16 cases with available details, 10 cases had the previous history of diabetes mellitus. The most frequent single site of involvement was maxillary sinus (7/25) followed by nasal cavity, orbit, ethmoid and sphenoid sinuses. While comparing the histological diagnosis with KOH mount findings and culture results, 15 cases revealed consistent results. Conclusion: A high clinical suspicion, monitoring, early diagnosis, and timely management can improve the morbidity and mortality of this life-threatening complication.

Vancomycin‑resistant Enterococcus faecium: Report of two cases.

Vancomycin‑resistant Enterococci (VRE), especially Enterococcus faecium has emerged as an important nososcomial pathogen and represents a serious threat to patients with impaired host defense. Early detection of patients colonised or infected with VRE is an essential component of any hospital program designed to prevent nosocomial transmission of this organism. The authors report two cases of VRE isolated from blood and surgical site pus of two neonates admitted in the same neonatal unit, highlighting that early detection, prompt and appropriate infection control measures were keys to successful containment of this dreaded pathogen.

Multiple giant congenital melanocytic nevi with central nervous system melanosis.

A case of multiple giant congenital melanocytic naevi in whom central nervous system melanosis was detected at 6 weeks of age is described. The infant was asymptomatic, but presence of risk factors such as multiple naevi, giant naevi and naevi on scalp and posterior axial location prompted a magnetic resonance imaging study of the brain. To our knowledge, neurocutaneous melanosis at such a young age has not been reported in Indian literature.

An unusual presentation of scurvy following head injury.

We report an unusual clinical presentation of scurvy in a one and half year old child. The child presented with abrupt onset of peri-orbital ecchymoses and scalp hemorrhage following head injury. The child also had a history of temper tantrums and head banging. Our case did not have any of the typical clinical features of scurvy. The diagnosis was eventually confirmed radiologically and by observing a dramatic response to vitamin C therapy. It is important to remember that scurvy can present atypically i.e. without bleeding gums, painful limbs, pseudo-paralysis or scorbutic rosary. Scurvy should be kept as a differential diagnosis in a young child presenting with bleeding manifestations. Taking a detailed dietary history is of utmost importance in pediatric practice.

Approach to learning disability.

Learning disabilities (LD) is one of the important causes of poor academic performance in school going children. Learning disabilities are developmental disorders that usually manifest during the period of normal education. These disabilities create a significant gap between the true potential and day to day performance of an individual. Dyslexia, dysgraphia and dyscalculia denote the problem related to reading, writing and mathematics. Perinatal problems are certain neurological conditions, known to be associated with LD; however, genetic predisposition seems to be the most probable etiological factors. Evaluation of a child suspected to be having LD consists of medical examination, vision and hearing test analysis of school performance. The psycho-behaviour assessment and education testing are essential in the process of diagnosis. The experienced persons in the field of LD should interpret the results of such tests. With Individualized Remedial Education Plan (IEP) most children learn to cope up with disability and may get integrated in a regular steam.

Noise pollution: a study of noise levels in the operation theatres of a general hospital during various surgical procedures.

Noise, defined as any unwanted or undesirable sound, is a known environmental pollutant and health hazard. Sound levels during the entire surgical procedures were measured in the operation theatres (OTs) of a general hospital in Delhi, using a sound level meter, B & K 2209, on the dB(A) scale. The sound levels were found to be higher as compared to the recommended international standands. The noise was contributed mainly by doors, trolleys, equipment and alarms and the incessant conversation among the operation theatre (OT) staff. It is well documented that noise is stressful eliciting changes in the autonomic nervous system, impairing mental faculties and producing masking that could affect the staff and the conscious patient alike, leading to decreased work performance and increased anxiety respectively. Better acoustic designing and maintenance of equipment together with an increased awareness of the OT staff towards this vital factor of work environment may effectively reduce the noise pollution in OTs.

Hepatic hydatid cyst rupturing into sub-diaphragmatic space and pericardial cavity.

A ten-year-old male child presented with a large hepatic hydatid cyst which ruptured into the sub-diaphragmatic space and pericardial cavity, giving rise to a pericardial effusion. This communication between the hydatid cyst and the pericardium was documented on computerised tomographic scan of the chest and abdomen. The cyst was aspirated carefully and then enucleated. There was an associated right-sided reactionary pleural effusion. The pericardial effusion and pleural effusion resolved on albendazole therapy and did not require surgical intervention.

Cerebellar atrophy in an epileptic child: is it due to phenytoin?

A four and half year old epileptic child on phenytoin therapy since one year presented with signs of cerebellar dysfunction. Serum phenytoin level was high (33 mcg/ml) and computerised tomographic scan of the brain showed severe generalised cerebellar atrophy. The cerebellar signs represented drug over dosage and toxicity and persisted long after omission of phenytoin.

Assessment of percent body fat content in young and middle aged men: skinfold method v/s girth method.

Percent body fat content was found in apparently normal healthy 30 young (17-20 Yrs.) and 30 middle aged men (30-46 Yrs.) by measuring the skinfold and girth. None of the subjects were athletes or did regular physical exercise. Body density was calculated using mean of the four skinfold measurements as per the equations advocated by Durnin and Womersley, while percent body fat content was calculated from the body density by the Siri's equation. The mean % body fat content by this method in young men was 15.87 +/- 3.85% and in middle aged men was 24.75 +/- 3.55%. Ten percent of the young subjects and 90% of the middle aged subjects were found to be obese. Percent body fat content was also calculated from the girth measurements as advocated by McArdle et al. The mean of % body fat content with this method was 14.91 +/- 3.82% in young men and 24.30 +/- 3.35% in middle aged men. On comparison, the difference in percent body fat content calculated by both the methods was found to be significant in young men but not for middle aged men. The correlation, coefficient between girth method and skinfold method was 0.95 in case of young men and 0.90 for middle aged men. Therefore, we advocate that girth measurements can be used to determine percent body fat content, main advantage being simplicity of technique and requirement of inexpensive instruments for measurement.

Evaluation of an innovative school eye health educational mode.

An innovative mode of using school children as health educators for transmitting messages on eye health care in the school environment was evaluated. Fifty children were evaluated at baseline and immediately after the educational session. A significant change in cognitive aspects of eye care was demonstrated (p < 0.001). Knowledge on vitamin A related aspects and childhood ocular trauma improved substantially compared to all other aspects of eye care.

Factors influencing survival in esophageal atresia.

There is little published literature from the third World countries that described the factors influencing survival of babies with esophageal atresia. We analysed 25 consecutive neonates treated for esophageal atresia. The overall survival rate was 36%. All 4 babies in Waterston Group A, 37.5% in Group B, and 15.4% in Group C survived. All 9 preterm babies died. Only 2 of the 16 babies who had pre-operative chest infection survived. The mean delay in diagnosis was 54 h in outborn babies and 20 h in hospital-born babies. We believe that a survival rate of 40% is easily achieved with minimum infrastructural inputs. Simple methods and practices that would vastly improve operative results have been suggested.

Comparative stabilities of glutaraldehyde & heat inactivated pertussis vaccine components of adsorbed DPT vaccine with different preservatives.

The stability of pertussis component (glutaraldehyde or heat inactivated pertussis vaccine) of the adsorbed diphtheria-pertussis-tetanus (DPT) vaccine preserved in thiomersal or benzethonium chloride was studied at 4-8 degrees C and 35 degrees C for 30 days. The potency of pertussis component of adsorbed DPT vaccine preserved with benzethonium chloride was lower than that preserved with thiomersal. After the initial loss of potency of pertussis component in the benzethonium chloride during blending, the stability of potency of pertussis component at 4-8 degrees C and 35 degrees C for 30 days was similar for vaccines preserved with either benzethonium chloride or thiomersal. The stability of both types of pertussis components inactivated with glutaraldehyde or heat was also similar at both the temperatures for 30 days.

Evaluation of the new rapid rabies immunodiagnosis technique.

The rapid rabies enzyme immuno-diagnosis (RREID) kit was evaluated for its sensitivity and specificity in comparison to fluorescent antibody technique (FAT) and biological test (BT) for the diagnosis of rabies. While 93 per cent correlation was observed in case of fresh brain samples, 71 per cent correlation was noted with glycerol preserved samples, where RREID was more sensitive than FAT. RREID test can be employed for rapid diagnosis of rabies, when facilities for FAT are not available. However, to test, at one time, small number of specimens, the RREID kit needs to be modified.

Correlation between mouse intracerebral potency & 50 per cent histamine sensitizing dose of pertussis vaccine.

A good correlation was observed between mouse intracerebral potency in terms of International Units and 50 per cent histamine sensitizing dose (HSD50) of various types of pertussis vaccine. The correlation was significant irrespective of the inactivating agent used for the preparation of pertussis vaccine. If the potency of the vaccine increased, the HSD50 decreased and vice versa showing a negative correlation between potency and HSD50. The relative histamine sensitizing (HS) activities of various types of pertussis vaccines in comparison to that of heat inactivated pertussis vaccine (HIPV) obtained in different experiments were very similar although the HSD50 values of same types of vaccines obtained in these experiments varied greatly. The conventional HIPV preparations having potency around 8 IU per 40 x 10(9) organisms had HSD50 values in the range of 1.0 to 2.2 x 10(8) organisms. The estimation of HSD50 of pertussis vaccine has been found to be a useful measure of the toxicity of the vaccine and also correlates well with the potency of the vaccine.