Immediate effect of virtual reality intervention on task related neck pain and muscle fatigue in dentists

Background: Dentistry requires long hours of static body postures while executing activities in which permanently forced loads influence the musculoskeletal system. Methods: 25 dentists were recruited where neck pain or fatigue was assessed subjectively using NRS and Borg CR10 scale respectively and the pain pressure threshold of the upper trapezius muscle was assessed objectively using a handheld algometer pre- and post- intervention. Mobile VR game- Froggy VR was administered as a virtual reality. Results: A Wilcoxon signed rank test showed a statistically significant reduction in the intensity of task related neck pain and fatigue post VR intervention with Z-score=-4.549, n=38, p<0.001 and Z-score=-4.588, n=38, p<0.001 respectively. Also, there was a statistically significant increase in the pain pressure threshold of the right and left upper trapezius muscle post VR intervention with Z-score=-4.937, n=38, p<0.001 and Z-score=-4.512, n=38, p<0.001 respectively. Conclusions: Virtual reality intervention led to an immediate reduction in task-related neck pain and muscle fatigue among dentists with an immediate reduction in pain sensitivity of the upper trapezius muscle in dentists.

A prospective study on emergence of mucormycosis in recently recovered COVID-19 patients

Background: Mucormycosis is an angio-invasive fungal infection with high morbidity and mortality. This infection seems to be increasing during the second wave of COVID-19. Objectives of this study were to identify and characterise the fungal species causing post-covid-mycosis, to analyze the cases for underlying co-morbidities if any and to correlate the associated risk factors with the progression of disease. Methods: Prospective observational study which constituted conventional fungal culture of 188 tissue specimens collected from clinically suspected mucormycosis patients who had history of COVID. Results: This study noted the occurrence of disease with predominance of males (72.03%). Most common symptoms were facial/periorbital swelling, followed by facial pain and headache. Among co-morbid conditions, diabetes mellitus was the most common (71.17%). Use of steroids (65.25%), antivirals therapy (22.86%), oxygen support (11.86%) used in management of COVID patients were found to be risk factors in post-covid-mucormycosis. radiological diagnosis showed involvement of paranasal sinuses (77.11%), followed by orbit (16.94%) and brain (5.90%). Mucor spp. was isolated in 21 cases. Although commonest fungus isolated was Aspergillus, analysis of the data for last 5 years showed a significant rise of Mucormycosis cases. Mortality was seen in 17.79% cases. Conclusions: Fungal aetiology should be kept in mind in patients with above clinical presentations with history of recent COVID-19 infection especially who received steroids.

Diagnostic utility of skin prick test in fungal asthma

Background: Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi. Aspergillus spp. predominates in colonizing the airways of asthmatics. Early and accurate identification of fungus in such cases can prevent worsening of asthma. Also, can help in retarding the progression of ABPM. Objectives of this study were to evaluate different fungal allergens associated with clinically diagnosed Asthma patients by Skin Prick testing (SPT), to study total IgE in asthmatic patients by serological testing and to characterize the fungal isolate associated with SPT+ cases by conventional mycological culture. Methods: A prospective study of known asthma cases was done. Their sensitivity to fungal allergens was tested by SPT. The total IgE levels were measured by ELISA. Sputum collected from SPT+ cases were subjected for fungal identification. Results: Out of 175 patients, 25 (14.2%) showed positive reaction against fungal antigens in which fungal growth was seen in 21 (84%) sputum specimens. Aspergillus fumigatus was isolated from 16 (76%) specimens followed by Candida albicans in 3 (14%) and Penicillium spp in 2 (9.5%) cases. Out of 25 SPT+ asthmatics, 21 patients with fungal growth had total IgE levels >600 IU/ml and 4 patients with negative culture had IgE levels 400-500 IU/ml. Conclusions: A significant prevalence of fungal asthma is seen among asthmatics. Thus, it is essential to screen asthma patients for fungal allergy. SPT seems to be a good screening test. SPT is easy to perform, less time consuming and inexpensive however needs to be performed under pulmonologist’s supervision.

Diagnostic utility of skin prick test in fungal asthma

Background: Allergic bronchopulmonary mycosis (ABPM) is a clinical syndrome associated with immune sensitivity to various fungi. Aspergillus spp. predominates in colonizing the airways of asthmatics. Early and accurate identification of fungus in such cases can prevent worsening of asthma. Also, can help in retarding the progression of ABPM. Objectives of this study were to evaluate different fungal allergens associated with clinically diagnosed Asthma patients by Skin Prick testing (SPT), to study total IgE in asthmatic patients by serological testing and to characterize the fungal isolate associated with SPT+ cases by conventional mycological culture. Methods: A prospective study of known asthma cases was done. Their sensitivity to fungal allergens was tested by SPT. The total IgE levels were measured by ELISA. Sputum collected from SPT+ cases were subjected for fungal identification. Results: Out of 175 patients, 25 (14.2%) showed positive reaction against fungal antigens in which fungal growth was seen in 21 (84%) sputum specimens. Aspergillus fumigatus was isolated from 16 (76%) specimens followed by Candida albicans in 3 (14%) and Penicillium spp in 2 (9.5%) cases. Out of 25 SPT+ asthmatics, 21 patients with fungal growth had total IgE levels >600 IU/ml and 4 patients with negative culture had IgE levels 400-500 IU/ml. Conclusions: A significant prevalence of fungal asthma is seen among asthmatics. Thus, it is essential to screen asthma patients for fungal allergy. SPT seems to be a good screening test. SPT is easy to perform, less time consuming and inexpensive however needs to be performed under pulmonologist’s supervision.

Epithelioid trophoblastic tumor: A case series

An epithelioid trophoblastic tumor (ETT) is an extremely rare gestational trophoblastic tumor. Cases of ETT present with abnormal vaginal bleeding in women of reproductive age group with marginally elevated beta human chorionic gonadotrophin (B-hCG) levels. Here, we describe a series of four patients (all were females) including histomorphology, immunoprofiles, and diagnostic difficulty of this rare entity. All cases were in their reproductive age group. The mean pre-treatment hCG level was 665.24 (mIU/mL). Microscopically, all cases had a tumor showing an epithelioid appearance arranged in large nests and sheets. Individual tumor cells were round to polygonal with abundant eosinophilic cytoplasm, with central vesicular nuclei and prominent nucleoli. Areas of hemorrhage, necrosis, and intercellular hyaline-like material deposition were identified in all cases (100%). Immunohistochemically, tumor cells in all cases showed diffuse positivity for AE1/AE3 and p63 (100%). GATA3 was available in one case (25%), which was positive in the tumor cells. In one case (25%), hPL was focally positive, and in one case (25%), it was negative. SALL4 was performed in two cases (50%) and was negative in tumor cells. The mean Ki67 labeling index was 19.2 (range 10–30%). All four patients underwent surgical intervention and were treated with hysterectomy. The mean follow-up in this series was 39.4 months (range 6–70), and all patients are alive to date with a mean survival of 32.8 months (range, 4–67).

Study of histopathology reports of loop electrosurgical excision procedure of cervical transformation zone and their correlation with preprocedural cervical biopsy and/or cytology: An audit

Introduction: Loop electrosurgical procedure of the transformation zone of the cervix (LEEP) is the preferred method for many investigators for early detection and treatment of high grade intraepithelial neoplasia(HGCIN). Histopathology reports of LEEP should contain information about the diagnosis, presence or absence of neoplasia ( with its grade) and comment on excison margins. Aim: Our aim was to study LEEP reports for its contents and to see their correlation with preprocudure histology and/or cytology report. Results: Between 2011 and 2017, 44 LEEP reports were archived and studied for their contents from our records. Slides were not reviewed. Mean age was 47.66 years (median 47 years). Forty two (( 95.45%) reports mentioned that all the tissue was examined. Deep cut examination was mentioned in 17/44 cases (38.64%). The concordance rate between LEEP and preprocudure histology and /or cytology for CIN II plus diagnosis is 65.9%. A strict definition is used. If, however, diagnoses between inflammation and CIN I, ASC-H and inflammation, and ASC-H and CIN I are considered non discordant, then the concordance rate rises to 72.7 %. The breakup of discordant cases is given. Conclusion: Literature shows wide range of concordance due to variable definitions and variety of reasons; possible reasons are discussed.

Epidemiology of male seminomatous and nonseminomatous germ cell tumors and response to first‑line chemotherapy from a tertiary cancer center in India.

INTRODUCTION: Unlike the developed countries, there is a lack of good epidemiologic data for testicular germ cell tumors (GCTs) in India with majority presenting in advanced stage. This study aims to elaborate on the epidemiology of testicular GCTs and response to standard first‑line chemotherapy (CT). METHODS: GCTs treated at our center from January 2013 to June 2014 were retrospectively analyzed. Patients underwent orchidectomy either outside or at our hospital. Based on stage and risk group, standard CT (bleomycin, etoposide, and cisplatin/etoposide and cisplatin/carboplatin AUC7) and radiotherapy were given as appropriate. Response was calculated based on the Response Evaluation Criteria in Solid Tumors. Statistical analysis was performed using SPSS 18 software. RESULTS: Fifty nonseminomatous germ cell tumor (NSGCT) and 36 of SGCT cases were studied. 30%, 46%, and 64% of NSGCT and 11%, 28%, and 22% of SGCT had N2, N3, and M1 diseases, respectively. The mean nodal size was 7 cm (1.5–19) in NSGCT and 5.5 cm (1.3–11) in SGCT. As per the International Germ Cell Cancer Collaborative Group classification, in patients with metastatic disease, 9% of NSGCT were good, 53% were intermediate, and 38% were poor risk whereas 75% of SGCT were good and 25% were intermediate risk. Following CT among NSGCT, 5% and 71% had radiologic complete response (CR) and partial response (PR), respectively. Among SGCT, 46% and 38% had radiologic CR and PR, respectively. 22%, 53%, and 13% of NSGCT and 12%, 24%, and 20% of SGCT developed febrile neutropenia, Grade 3 or 4 hematological and nonhematological toxicities, respectively, after standard chemotherapy. CONCLUSIONS: GCTs in India present with high nodal and high‑risk diseases wherein the standard first‑line CT may not be adequate as curative therapy; however, significant chemotoxicity is also a hindrance.

Cutaneous histoplasmosis in AIDS.

A patient with human immunodeficiency virus (HIV) infection presented with multiple cutaneous lesions on upper extremities, trunk, face and with ulcers involving oral mucosa. Histoplasma capsulatum was isolated in culture from scrapings from both cutaneous as well as oral mucosal lesions. The patient responded well initially to the treatment with Amphotericin B followed by itraconazole; however, lesions recurred after three months with the further deterioration of immune status of the patient indicated by decline in CD4 counts. The same treatment was restarted and the patient is still being followed-up.

Utility of in vitro proton magnetic resonance spectroscopy in aetiological characterisation of brain abscesses.

Purpose: Brain abscesses often present an aetiological dilemma. Microscopy is insensitive and culture techniques are time consuming. Hence, a new rapid technique in vitro Proton Magnetic Resonance Spectroscopy ( 1 HMRS) was evaluated for its usefulness in the identification of aetiology of brain abscesses. Materials and Methods: A total of 39 pus specimens from brain abscesses were subjected to in vitro 1 HMRS. These pus specimens were also processed by conventional culture methods. The spectral patterns generated by in vitro 1 HMRS were further correlated with culture results. Results: Pus specimens which showed the presence of anaerobes on culture revealed the presence of multiplet at 0.9 ppm (100%), lactate-lipid at 1.3 ppm (100%), acetate at 1.92 ppm (100%) and succinate at 2.4 ppm (75%). Pus specimens that revealed the presence of facultative anaerobes on culture showed a pattern B, i.e., the presence of lactate-lipid at 1.3 ppm (100%), acetate at 1.92 ppm (88.88%) along with the multiplet at 0.9 ppm (100%). Pattern C was seen in aerobic infection which showed the presence of lactate-lipid at 1.3 ppm (100%) along with the multiplet at 0.9 ppm. Pus from two tuberculous abscesses showed the complete absence of multiplet at 0.9 ppm. Conclusions: We observed in this study that it was possible to differentiate bacterial and tuberculous brain abscesses using in vitro 1 HMRS. Further, it was also possible to distinguish between aerobic and anaerobic brain abscesses on the basis of spectral patterns. In vitro 1 HMRS of fungal and actinomycotic brain abscess are also presented for its unusual spectra.

Rapid identification of non-sporing anaerobes using nuclear magnetic resonance spectroscopy and an identification strategy.

PURPOSE: The non-sporing anaerobes cause a wide spectrum of infections. They are difficult to culture and their identification is tedious and time-consuming. Rapid identification of anaerobes is highly desirable. Towards this end, the potential of nuclear magnetic resonance (NMR) spectroscopy for providing a fingerprint within the proton spectrum of six genera belonging to anaerobes reflecting their characteristic metabolites has been investigated. METHODS: NMR analysis was carried out using Mercury plus Varian 300 MHz (7.05 T) NMR spectrophotometer on six different anaerobes. These included Bacteroides fragilis, Prevotella melaninogenica, Prevotella denticola, Fusobacterium necrophorum, Peptococcus niger and Peptostreptococcus spp. After the NMR analysis (256/512 scans), the different peaks were noted. The eight pus specimens, which yielded pure culture of anaerobe, also were analysed similarly. RESULTS: The major resonances of multiplex of amino acids/lipid at 0.9 ppm along with lactate/lipid at 1.3 ppm, acetate at 1.92 ppm and multiplex of lysine at 3.0 ppm remained constant to label the organism as an anaerobe. There was a difference found in the MR spectra of different genera and species. A simple algorithm was developed for the identification of the six different anaerobes studied. The MR spectra of the pure culture of the organism matched the MR spectra of pus from which the organism was isolated. CONCLUSIONS: MR-based identification was of value in the identification of anaerobes. However, a larger database of the peaks produced by anaerobes needs to be created for identification of all genera and species. It could then have the potential of diagnosing an anaerobic infection in vivo and thus expedite management of deep-seated abscesses.

Plasma levels of genistein following a single dose of soy extract capsule in Indian women.

BACKGROUND & OBJECTIVE: Soy isoflavones are being used as therapy for menopausal syndrome in many countries. Marketed preparations show variability in bioavailability and there are variations in kinetics due to ethnicity and diet. Inspite of soy isoflavone being available in the Indian market there are no studies to show whether the preparation is likely to be effective in women. This study was carried out to determine circulating levels of genistein, a bioactive soy isoflavone, in Indian women after a single dose of soy extract. METHODS: Six healthy vegetarian women volunteers, between 36 and 62 yr and with a mean body mass index (BMI) 25.01+/-2.02 (kg/m2), were enrolled after an informed consent. Women with antibiotic or Soy food intake within 1 month of study were excluded. A single dose of standardized soy extract capsule containing 64.12 mg of total isoflavones (genistein content equivalent to 31.76 mg) was ingested under supervised fasting condition and multiple blood samples were collected at 0, 1, 2, 4, 6, 8 and 24 h. Genistein levels were measured by high performance liquid chromatography (HPLC) method with a detection level of 2.5 ng/100 microl of injection volume. The intra- and inter-assay coefficients of variation were < 5.32 per cent. RESULTS: Genistein was detected (10.3 to 16.2 ng/ml) in 3 volunteers in baseline samples. Within one hour genistein levels rose from 42 ng to 215 ng/ml with a maximum concentration of 117 to 380 ng/ml at 4 to 8 h. A secondary peak suggestive of enterohepatic circulation was seen between 4 and 6 h in 2 out of 6 volunteers. The mean Cmax was 315.5 +/- 57.1 ng/ml. All women had detectable levels from 25.2 to 109.3 ng/ml at 24 h. INTERPRETATION & CONCLUSION: Our study showed adequate circulating levels of genistein in Indian vegetarian women after a single dose of soy extract. Variability in plasma levels of the soy isoflavones may explain differences in responses to therapy.

Significance of HBV DNA by PCR over serological markers of HBV in acute and chronic patients.

A study was undertaken to determine Hepatitis B virus DNA (HBV DNA) by PCR in acute and chronic hepatitis B infection and to correlate it with serological markers. Three hundred and forty-five serum samples of patients from all over India were categorized into different groups according to their serological profile. HBV DNA was detected upon amplification in 166/263 patients in group A, 3/14 patients in group B, and 2/32 patients in group C, and was not detected in groups D and E. The presence of HBV DNA in 49 patients with non-replicative HBV disease, as defined by the absence of HBeAg, suggests low levels of viremia which is also supported by the abnormal liver function tests (LFTs) in these patients. In addition, HBV DNA was detected in small proportion of individuals with past HBV infection. This data suggests that, detection of HBV DNA by amplification technique serves as an important supplementary tool besides serology in a number of clinical settings, especially in determining low levels of viremia in patients with non-replicative HBV disease and chronic hepatitis, and also in a few patients with past HBV infection and who could be asymptomatic carriers of HBV infection.

Spectrum of antibiogram against pathogens related to respiratory tract infections with a special reference to ceftibuten: a multicentric study.

In a multicentric study at several leading hospitals of this country, microbiological assessment was carried out in 500 specimens from patients suffering from respiratory tract infections (RTIs; both upper and lower) for a period of 6 months from January, 1999 to June, 1999. The antibiotic sensitivity study was done in 201 isolates from 500 different specimens of throat swab, postpharyngeal swab, sinusitis drainage fluid, sputum, broncho-alveolar lavage (BL), etc. Ceftibuten, an orally active third generation cephalosporin showed encouraging results when compared with seven other selected antibiotics used for RTI. The majority of the patients with acute or chronic RTIs showed an excellent in vitro response to ceftibuten in the analysis of the isolates. Seventy to ninety per cent of the isolated respiratory pathogens were found to be sensitive to ceftibuten in vitro; which offers a promising alternative to other antibiotics included in this study.