Mucormycosis an Emerging Fungal Infection Associated with COVID-19- A Case Report

Introduction: Mucormycosis is an exceptional but rising fungal infection correlated with the COVID-19 disease. COVID-19 positive patients exhibiting severe symptoms admitted in the ICU have an increased susceptibility to develop bacterial and fungal infection. We hereby report a case of oral mucormycosis that is seen in a patient in post COVID-19 infection. Case Presentation: A 65-year-old woman presented to our institution, with the chief complaint of ulceration in her right palate region for the past 7 days along with pyrexia and generalised malaise. The patient reported to have recovered from COVID-19 infection recently. She presented with medical history of diabetes and hypertension for past 8 years. Post recovery from COVID-19 infection the patient developed an ulcer in the hard palate. Treatment: Surgery was done under General anesthesia. Maxillectomy was done with aggressive debridement of necrotic tissue. Bilaterally periosteal flap was approximated and suture was placed. Conclusion: The extensive use of steroids and broad-spectrum antibiotics in COVID-19 treatment may raise the risk of fungal infections. Medical practitioners should be aware of the possibility of invasive secondary fungal infections in patients with COVID-19 infection.

Rapid identification of clinical mycobacterial isolates by protein profiling using matrix assisted laser desorption ionization-time of flight mass spectrometry.

Purpose: The purpose of this study was to evaluate the identification of Mycobacterium tuberculosis which is often plagued with ambiguity. It is a time consuming process requiring 4-8 weeks after culture positivity, thereby delaying therapeutic intervention. For a successful treatment and disease management, timely diagnosis is imperative. We evaluated a rapid, proteomic based technique for identification of clinical mycobacterial isolates by protein profiling using matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS). Materials and Methods: Freshly grown mycobacterial isolates were used. Acetonitrile/trifluoroacetic acid extraction procedure was carried out, following which cinnamic acid charged plates were subjected to identification by MALDI-TOF MS. Results: A comparative analysis of 42 clinical mycobacterial isolates using the MALDI-TOF MS and conventional techniques was carried out. Among these, 97.61% were found to corroborate with the standard methods at genus level and 85.36% were accurate till the species level. One out of 42 was not in accord with the conventional assays because MALDI-TOF MS established it as Mycobacterium tuberculosis (log (score) >2.0) and conventional methods established it to be non-tuberculous Mycobacterium. Conclusions: MALDI-TOF MS was found to be an accurate, rapid, cost effective and robust system for identification of mycobacterial species. This innovative approach holds promise for early therapeutic intervention leading to better patient care.

Interactions of bacterial polysaccharides with cationic dyes: Physicochemical studies.

Capsular polysaccharides (SPS) are an integral component of gram-negative bacteria, and also have potential use as vaccine. In this paper, interactions of SPS isolated from Klebsiella strains K20 and K51 with cationic dyes pinacyanol chloride (PCYN) and acridine orange (AO) were studied by absorbance and fluorescence measurements. Both the polysaccharides having glucuronic acid as the potential anionic site induced strong metachromasy (blue shift ~100 nm) in the PCYN. The spectral changes were studied at different polymer/dye molar ratios (P/D = 0-40). A complete reversal of metachromasy was observed upon addition of co-solvents, suggesting the breakaway of dye molecules from the biopolymer matrix. Binding constant, changes in free energy, enthalpy and entropy of the dye polymer complex were also computed from the spectral data at different temperatures to reveal the nature of the interaction. Quenching of fluorescence of AO by the polymers and the incorporated mechanisms were also explored.

Safety of primary intraocular lens insertion in unilateral childhood traumatic cataract.

This study analyzes the results of cataract surgery with primary intraocular lens implantation in unilateral childhood traumatic cataract following penetrating trauma and its long term follow up. It is a hospital based study of 114 children (age 3-10 years) with unilateral traumatic cataract who underwent extracapsular cataract extraction/ lens aspiration with implantation of posterior chamber intraocular lens (IOL). Primary posterior capsulotomy (PPC) was performed in 57 eyes and the rest 57 were without PPC (NPPC). The patients were followed up at regular intervals for a period of 3 years. Postoperative inflammation and pupillary capture were two frequent complications seen during postoperative period. Development of posterior capsular opacification (PCO) was 1/57, 4/57 at 8th week and 7/30 and 14/39 at 6 months, in PPC and NPPC group, respectively. Best corrected visual acuity (BCVA)>or=6/18 was achieved in 50% of eyes at 8th week post operatively and the same at 3 years with/without membranectomy/capsulotomy was evident in 73.3% of eyes. Meticulous case selection with insertion of "in the bag IOL" and subjecting the traumatized cataractous eyes to primary posterior capsulotomy are factors responsible for optimal outcome in unilateral traumatic cataract in children.

Rabies: control strategies for Himalayan states of the Indian subcontinent.

Rabies remains to be one of the most important direct zoonosis and is invariably fatal once the clinical symptoms appear. The disease can be prevented but still people continue to die of infection. India alone accounts to 81 per cent of the total deaths occurring due to rabies across the world. Dog is major reservoir of the infection, although other domestic and wild reservoirs also play an important role in the spread of the disease. A large population of stray dogs, availability of susceptible hosts, close proximity of animals and man and lack of effective control strategies might have led to endemic status of the disease in India. The effective control of rabies can be achieved through reduction of the stray dogs and stray livestock populations through implementation of animal birth control (ABC) programme and the proper induction of "herd immunity" by mass vaccination and awareness health programme. The increase in human population, changes in the environment, increased transportation, development of human habitations in new places and seasonal migration of the animals have resulted in the introduction of the infection to new territories and changes in the epidemiology of the disease in hills. Therefore, it is essential to design area specific control programmes so that the disease can be eliminated effectively.

Viscoexpression of large free floating Cysticercus cyst from the anterior chamber of the eye by double incision technique.

We describe a case of 16-year-old girl who reported with diminution of vision in left eye for past seven months with appearance of white reflex. Slit lamp biomicroscopy revealed the presence of a live grayish white cyst in the anterior chamber. The ultrabiomicroscopic evaluation revealed a large live Cysticercus cellulosae cyst in anterior chamber. The CT-scan of the brain revealed multiple non-contrast enhanced lesions with calcification in brain parenchyma. The patient was started on oral prednisolone and oral albendazole. The cyst was removed in toto from the eye by double incision technique. The patient achieved visual acuity of 6/12 post-operatively.

Striving for the perfect surgery in traumatic cataract following penetrating trauma in a tertiary care hospital at eastern Nepal.

This study analyzes the result of traumatic cataract surgery in a tertiary care hospital at eastern Nepal. It is a hospital-based study of 112 patients (age 15-62), who underwent cataract extraction for unilateral traumatic cataracts. The study was carried out to evaluate the surgical outcome of tramatic cataract. Thirty-eight eyes had associated posterior capsular defect. No serious postoperative complications were encountered. Posterior capsular opacification at the end of sixth week was evident only in two eyes. Best corrected visual acuity nof 6/18 or more at the eighth week was achieved in 61 (54%) eyes. Astigmatism of less than 3D was achieved in 82 (73%) eyes. Rational surgical approach in traumatic cataract provides encouraging results. To comment on actual outcome long term follow up is mandatory.

Prevalence of glaucoma in Sunsari district of eastern Nepal.

AIMS: To determine prevalence of glaucoma and glaucoma suspect in subjects 40 years and above in Sunsari district of eastern Nepal. METHODS: A community based cross sectional study examining 1600 selected subjects was carried out. In all subjects best corrected visual acuity was determined. Oblique torch light test was used for anterior chamber depth evaluation. Intraocular pressure (IOP) measurements with Perkins tonometer and fundus examination were carried out in the community. Subjects diagnosed as glaucoma suspect were further evaluated in the hospital using slit lamp examination, gonioscopy and Goldmann perimetry. Glaucoma was defined by characteristic disc and visual field changes irrespective of the level of IOP. RESULTS: Of 1600 subjects examined, the prevalence of glaucoma was found to be 0.938%. The prevalences of primary open angle glaucoma, primary angle closure glaucoma, secondary glaucoma and ocular hypertension were 0.562%, 0.125%, 0.250% and 0.500% respectively. Lens induced glaucoma accounted for all the cases of secondary glaucoma. CONCLUSION: The prevalence of glaucoma in the Sunsari District of Nepal is 0.938%, which is lower than that reported in the neighboring regions. Lens induced glaucoma is highly prevalent as a cause of secondary glaucoma.

Pattern of intraocular pressure changes following manual small incision cataract surgery.

OBJECTIVES: To find out the pattern of changes in intraocular pressure after manual small incision cataract surgery. METHODS: Consecutive patients (291 eyes of 291 patients) undergoing manual small incision cataract surgery were prospectively evaluated for change in IOP. Patients were further divided into two groups based on whether or not sutures were used to close the scleral tunnel. IOP was serially measured at day 1, 1st, 2nd, 4th, 6th, 8th and 12th week. RESULTS: The mean post operative IOP in eyes where sutures were not applied (12.59+/- 3.02 mmHg, 12.59+/-2.34mmHg, 12.54+/-2.19mmHg and 12.40+/-2.99 mm Hg at day1, 2week and 4weeks respectively) was lower than that where sutures were used to close the wound (15.57+/- 3.86mmHg, 14.05+/-2.52mmHg, 14.43+/-3.39mmHg at day1, 2weeks and 4 weeks respectively). There was a drop of IOP from the preoperative IOP in both suture (1.15+/-3.29mm Hg) and non suture (3.29+/-3.07mm Hg) group at 3 months of follow up. CONCLUSION: There is a small drop of IOP following sutureless MSICS during long term follow up. Eyes where sutures are applied are more likely to have higher IOP than those without sutures at the initial post operative period.

Purification and partial characterization of PfHRP-II protein of Plasmodium falciparum.

The human malarial parasite Plasmodium falciparum secretes various intra-and extra-cellular proteins during its asexual life cycle in human RBC. Histidine rich protein-II (HRP-II) is one of the most prominent proteins, found to be secreted by P. falciparum throughout the asexual cycle with the peak during mature schizont stage of the parasite development in human IRBC. The high histidine content (35% of the total amino acids in protein) of this protein suggested the potential to bind divalent metal ions. We have demonstrated by metal chelate chromatography, an extraordinary capacity of HRP-II to bind nickel ions (Ni++) and employed this characteristic to purify the extra-cellular HRP-II protein secreted by P. falciparum from culture supernatant. The identity of the purified protein was verified by the relative molecular weight on SDS-PAGE, by reacting with polyclonal antibodies directed against it using Western blot technique.

Applicability of Demirjian's method of age assessment in children of Davangere.

The assessment of age is an important facet in providing information in demographic studies and is of clinical use to diagnose and plan the treatment. The objective of this study was to determine whether the standards of dental maturation given by Demirjian et al are applicable to Davangere children and to assess the relationship between the obtained dental age and skeletal age. The study group comprised of 151 healthy children of 6-15 years age. It was found that Davangere children were dentally more advanced. Demirjians method gave an over estimation of 1.20 +/- 1.02 years and 0.90 +/- 0.87 years in males and females respectively. The obtained dental age was found to be different from the skeletal age. It may be concluded that Demirjians method of dental maturation is not applicable to the children of Davangere.

Therapy of acanthamoeba keratitis--an experimental study.

The study was conducted to determine the efficacy of various drugs/agents in the treatment of experimentally induced Acanthamoeba Keratitis (A. keratitis). Thirty rabbits were divided into 5 equal treatment groups and polyhexamethylene biguanide (PHMB) 0.02%, fluconazole 0.2%, povidone iodine 5%, aprotinin 40 IU/ml and normal saline were administered in a double blind manner, at a dose of one drop, 5 times/day. Neomycin 1700 U/ml was used as a common drug in all groups, with same frequency. Post therapy subsidence of lid oedema, mucopurulent discharge, conjunctival congestion, corneal epithelial defect and anterior chamber reactions were noted. Average healing time in days (Mean +/- S.D.) were 13.67 +/- 1.21, 22 +/- 1.41, 23.5 +/- 1.05, 17.0 +/- 1.41 and 28.0 +/- 1.90 for PHMB, fluconazole, povidone iodine, aprotinin and normal saline respectively. Lid oedema, mucopurulent discharge and conjunctival congestion improved faster in PHMB and aprotinin treated eyes. The results of this study suggest that PHMB is a better drug for A. keratitis, while aprotinin may be used as an adjuvant drug in the management of A. keratitis.

Spectral studies on the interaction of iodine and anthracene sulfonate with bacterial phospholipids from different mutants of Salmonella minnesota.

Using spectrophotometric and spectrofluorometric techniques, the interaction of iodine and 2-anthracene sulfonate (ANS) with the phospholipids (PL) isolated from four genetically correlated Salmonella minnesota isolates viz., a smooth form (S), a deeply rough mutant (Rc) and two intermediate forms (Ra and Rb) were studied. Appearance of an isosbestic point and a new band in absorption spectra indicated charge-transfer (C-T) interaction of iodine with the PL through the formation of 1:1 complex. Stern-Volmer type fluorescence quenching of PL was observed with the addition of iodine to PL, while PL enhanced the fluorescence of anionic dye ANS. The values of the binding constants between iodine/PL and ANS/PL, measured by using suitable equations, showed a systematic gradation in the molecular properties of the PL in the membrane structure in smooth (S) and rough (Ra, Rb and Rc) mutants of Salmonella minnesota.

Keratoplasty and cataract extraction.

Fifty eyes were evaluated following penetrating keratoplasty and cataract extraction. Twenty five of them had intracapsular lens extraction while the remaining 25 had intercapsular method of extracapsular lens extraction. Both operative and post operative complications were more in group I. Visual outcome and graft clarity were also better in eyes of group II. Combined keratoplasty and intercapsular method of extracapsular lens extraction was recommended in eyes having both corneal and lenticular pathology.

Corneal endothelial changes following pars plana lensectomy.

The corneal endothelial status was studied in 40 eyes of patients with congenital cataract before and 3 months after surgery. Twenty eyes of patients who underwent pars plana lensectomy revealed a mean endothelial cell loss of 8% (SD +/- .76) while the remaining 20 eyes which were operated by needling aspiration had a endothelial cell loss of 10% (SD +/- .89). The difference between the two groups was not statistically significant.

Sickle haemoglobin, G-6PD deficiency and malaria in western Orissa.

Sixty cases of malaria were screened for sickle haemoglobin and G-6PD deficiency. Plasmodium vivax was detected in 40 (66%) and Plasmodium falciparum in 21 (35%) cases, with six of the latter having cerebral manifestation. Sickle Hb was found in 7 (11.5%) patients and G-6PD deficiency in 3 (5%) cases. Both patients with SS disease had vivax malaria, while of 5 with sickle cell trait 3 had only vivax, one only falciparum and one mixed infection. Amongst G-6PD deficient patients one had vivax and two falciparum malaria. One of the latter had both SC trait and G-6PD deficiency. Thus, adult persons with SS disease or SC trait were not found to be resistant to either vivax or falciparum malaria. A high frequency (5%) of G-6PD deficiency amongst malaria patients warrants a caution against indiscriminate use of 8-aminoquinoline drugs.

Sister chromatid exchanges in congenital cataracts.

A total of 25 patients with bilateral congenital cataracts, from three aetiological groups i.e. rubella (6 patients) hereditary (6 patients) and undetected aetiology (13 patients) were studied for sister chromatid exchanges (SCE). SCEs were markedly raised in the rubella groups as compared with age sex matched controls. The other two groups also showed raised SCE, more so in hereditary group.

Dermatoglyphic profile in congenital cataracts.

Forty-five children with congenital cataract cases were studied for patterns and compared with age sex matched controls. The patients showed marked differences in different dermatoglyphic traits. The intra uterine aetiological groups i.e. rubella, hereditary and undetected aetiology, showed variations in mainline terminations. Rubella group showed increased angle atd.

Ocular manifestations of rheumatoid arthritis.

One hundred and seven patients of definite rheumatoid arthritis were screened for the presence of ocular manifestations of which 21 (19.63%) were observed to have ocular changes. Of these keratoconjunctivitis sicca in 19 (17.7%) patients and episcleritis in one (0.93%) were attributable to rheumatoid arthritis. Bilateral retinal haemorrhage in one patient was due to grade 3 hypertensive retinopathy. Absence of posterior subcapsular cataract in 106 (99.06%) patients who did not receive corticosteroids supports the hypothesis that steroids are the aetiologic agents and not rheumatoid arthritis.