Mucocutaneous manifestations of COVID-19-associated mucormycosis: A retrospective cross-sectional study

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.

An overview of mycetoma and its diagnostic dilemma: Time to move on to advanced techniques

The neglected tropical disease mycetoma can become extremely devastating, and can be caused both by fungi and bacteria; these are popularly known as eumycetoma and actinomycetoma respectively. The classical triad of the disease is subcutaneous swelling, multiple discharging sinuses and the presence of macroscopic granules. The present study aims to highlight the existing diagnostic modalities and the need to incorporate newer and more advanced laboratory techniques like pan fungal/pan bacterial 16S rRNA gene polymerase chain reaction (PCR) and sequencing, Matrix-assisted laser desorption/ionization-time of flight mass spectrometry (MALDI-TOF MS), rolling circle amplification (RCA), loop-mediated isothermal amplification (LAMP) and recombinase polymerase amplification (RPA). It is important for the medical team to be aware of the various diagnostic options (both existing and future), so that diagnosis of such a debilitating disease is never missed, both by clinicians and microbiologists/pathologists. The newer diagnostic methods discussed in this article will help in rapid, accurate diagnosis thus facilitating early treatment initiation, and decreasing the overall morbidity of the disease. In the Indian context, newer technologies need to be made available more widely. Making clinicians aware and promoting research and development in mycetoma diagnostics is the need of the hour.

Differences in COVID-19 mortality in males and females: Is estrogen hormone attributing to sex differences?

Objectives: Globally, the case fatality ratio is more in males versus females. Some studies have suggested estrogen hormone decreases susceptibility to SARS CoV-2. We have analyzed the observed sex differences in COVID-19 behavior in males and females and the clinical profiles of females of different age groups of COVID-19 patients and discussed their symptoms, laboratory evaluations, and associated comorbidities. Material and Methods: The patients were tested for COVID-19 through real-time RT-PCR (Reverse Transcription Polymerase Chain Reaction) assay. The data obtained were studied for the epidemiological, clinical, and laboratory characteristics from their medical records. Results: The mortality rate in females was 12.33% (36/292) whereas mortality in males was 19.63% (84/428). In between group analysis, 8.7% (14/161) of females died in the <40 years age group versus 16.8% (22/131) in more than 40 years age group whereas in males, the mortality was 13.7% (21/153) in <40 years versus 22.9%(63/275). The mortality rate in women older than 40 years was greater than mortality in younger females emphasizing the protection provided by estrogen hormone in them. The proportion of patients who expired due to COVID-19 significantly differs by age cutoff of 40 years, X2 (1, n = 428). The difference is statistically significant at P < 0.05. Males more than 40 years are more likely to expire. Conclusion: Sex-related differences in coronavirus pandemic have been found pointing toward the protective role of estrogen hormone and other differences in immunological behavior in males and females. Downregulation of ACE2 expression, thereby reducing viral entry, might also be contributory to decreasing mortality in females.

Labial fusion: A rare cause of obstructive lower urinary tract symptoms in old age females

Lower urinary tract symptoms in females can be due to various factors. Most of the time it is due to simple urinary tract infection and lower urinary tract pathology such as urethral stricture, meatal stenosis, bladder stones, underactive detrusor, and primary bladder neck obstruction. Commonly found neurologic causes among females are detrusor–external sphincter dyssynergia, associated with various brain and spine diseases and diabetic neuropathy. Labial fusion is a rare cause of female voiding difficulty. We herein present two elderly postmenopausal diabetic female patients who had nearly total urethral occlusion due to labial fusion. After thorough history taking and local genitourinary examination, the patients were operated. Treatment included surgical correction followed by the local application of 1% estrogen ointment. Both patients were symptom-free after the procedure. Thus, with a correct diagnosis followed by simple operative procedure, we can treat such patients successfully.

Primary retroperitoneal extraovarian granulosa cell tumor

Extraovarian granulosa cell tumors (GCTs) develop from ectopic gonadal tissue situated along the embryonal route of the genital ridge. Primary retroperitoneal tumors are extremely rare, with an incidence of 02% -06% and 80-85% probability of malignancy. Only eight such case reports have been published previously. We herein, report a rare case of extraovarian retroperitoneal GCT in a 55-year-old woman who presented with intermittent left lumbar region pain of one-year duration. She had a history of hysterectomy and bilateral salpingo-oophorectomy 8 years ago for uterine leiomyoma. Laparotomy revealed a retroperitoneal mass measuring 8cm x 10cm x 20cm in size, solid cystic with areas of necrosis and hemorrhage. The gross features, classical histopathology, and positive immunostaining of the retroperitoneal mass with inhibin, calretinin, PR, WT1 and immunonegativity for EMA were characteristic of adult-type GCT. Excluding any previous history of primary ovarian GCT in this patient, a de-novo retroperitoneal diagnosis was established.

Three Port Versus Four Port Laparoscopic Cholecystectomy : A Comparative Study

Aims & Objectives: To compare three port–laparoscopic cholecystectomy (3 LC) with four port–laparoscopic cholecystectomy in term of safety, efficacy, post–op pain, hospital stay and complication rates. Material & Methods: The present study was conducted in the department of Surgery, S.N. Medical College, Agra (U.P.). Total 104 adult patients of cholelithiasis with chronic cholecystitis were included in the study. These 104 patients were randomly divided into two group (I & II) consisting of 52 patients in each group. Study was conducted for a period of 1 year from Jan. 2017 to Jan. 2018. Group–I: performed 3 port LC (3 port–laparoscopic cholecystectomy) Group–II: performed 4 port LC (4 port–laparoscopic cholecystectomy). The present study is being conducted to compare the various merits and demerits of 3 port LC and 4 port LC performed by same surgical team in the same scenario in our setup in our medical college. Results: Statistically significant different was found between the two group in term of visual analogue score for pain at 6 and 24 hr, analgesic requirement, duration of hospital stay and back to work and cosmetic outcome all being less in the three port LC group. Result of other variable were comparable in the two groups. Conclusion: Three port laparoscopic cholecystectomy resulted in less port site pain and better cosmetic outcome require fewer analgesic, fewer surgical scar and without increase in complication with shorter duration of hospital stay.

Synergistic protective effect of picrorhiza with honey in acetaminophen induced hepatic injury.

Rhizome of picrorhiza along with honey prevents hepatic damage and cure the acetaminophen (paracetamol) induced hepatotoxicity by modulating the activity of hepatic enzymes. Here, we studied the in vivo effects of Picrorhiza kurroa and honey on acetaminophen induced hepatotoxicity Balb/c mice model. Hepatic histopathological observations of acetaminophen fed (day-6) group showed more congestion, hemorrhage, necrosis, distorted hepatic architecture and nuclear inclusion. Such damages were recompensed to normal by picrorhiza or honey alone or both in combinations. We observed increased activity of SGPT and SGOT in injured liver tissues, and that too was compensated to normal with picrorhiza or honey alone or both in combinations. We observed 1.27 and 1.23-fold enhanced activity of SGPT in serum and liver lysate, respectively while SGOT showed 1.66 and 1.11 fold enhanced activity. These two enzymes are signature enzymes of liver damage. Thus, our results support that honey may be used with drug picrorhiza due to its synergistic role to enhance hepatoprotective and hepatoregenerative ability along with allopathic drugs to mitigate the hepatotoxic effects.

Assessment of serum interleukin-8 as a sensitive serological marker in monitoring the therapeutic effect of levamisole in recurrent aphthous ulcers: A randomized control study.

Aim: The study was designed to evaluate the serum interleukin‑8 (IL‑8) levels in patients with recurrent aphthous ulcer (RAU) and monitor the immunomodulation and altered IL‑8 levels by levamisole before therapy and after levamisole therapy. Materials and Methods: This study was carried as a randomized case‑control study involving a study group of 30 patients diagnosed as RAUs and given levamisole (vermisole 150 mg, od for 1st 3 days of 3 weeks in a month and for 3 months with a gap of 1 week) and these patients were recalled after 3 months and were subjected for estimation of serum IL‑8 levels. Control group had 20 age and sex matched individuals with no systemic illness and were not given any levamisole. Good compliance was reported at the end of the study. Results: Mild gastric irritation was reported and when severe it was managed by H1 blocker. Patients were reviewed after 3 months. The follow‑up data at each visit with respect to each other and to base‑line values was calibrated using a Students t‑test. Highly significant comparisons were obtained in the serum IL‑8 between study and control groups before the onset of levamisole (t = 6.53, P ≤ 0.001). IL‑8 levels reduced by 72% after levamisole was instituted in RAU patients and comparison was highly significant for before and after levamisole onset (t = 5.54, P ≤ 0.001). Conclusion: This study points to the effectiveness of levamisole as an effective adjunct therapy in the routine management of RAU.

Impact of Janani Suraksha Yojana on Institutional Delivery Rate and Maternal Morbidity and Mortality: An Observational Study in India.

The Government of India initiated a cash incentive scheme—Janani Suraksha Yojana (JSY)—to promote institutional deliveries with an aim to reduce maternal mortality ratio (MMR). An observational study was conducted in a tertiary-care hospital of Madhya Pradesh, India, before and after implementation of JSY, with a sample of women presenting for institutional delivery. The objectives of this study were to: (i) determine the total number of institutional deliveries before and after implementation of JSY, (ii) determine the MMR, and (iii) compare factors associated with maternal mortality and morbidity. The data were analyzed for two years before implementation of JSY (2003-2005) and compared with two years following implementation of JSY (2005-2007). Overall, institutional deliveries increased by 42.6% after implementation, including those among rural, illiterate and primary-literate persons of lower socioeconomic strata. The main causes of maternal mortality were eclampsia, pre-eclampsia and severe anaemia both before and after implementation of JSY. Anaemia was the most common morbidity factor observed in this study. Among those who had institutional deliveries, there were significant increases in cases of eclampsia, pre-eclampsia, polyhydramnios, oligohydramnios, antepartum haemorrhage (APH), postpartum haemorrhage (PPH), and malaria after implementation of JSY. The scheme appeared to increase institutional delivery by at-risk mothers, which has the potential to reduce maternal morbidity and mortality, improve child survival, and ensure equity in maternal healthcare in India. The lessons from this study and other available sources should be utilized to improve the performance and implementation of JSY scheme in India.

Hydrogen peroxide-scavenging enzymes impart tolerance to high temperature induced oxidative stress in sugarcane.

Seventy-one genotypes of sugarcane from diverse agro-climatic zones of India viz. peninsular, northwest, north-central and eastern zones, were screened for their tolerance to high temperature stress based on the damage to leaf biomass i.e. necrosis of leaf-tips and margins, and rolling of leaves. Nine selected genotypes showing variable response to heat injury were tested for activity pattern of isoforms of two H2O2-scavenging enzymes; ascorbate peroxidase (APX) and catalase (CAT), under high temperature induced oxidative stress. Changes in the activity of APX and CAT isozymes in leaves corresponded to the level of tolerance of genotypes towards heat injury which was substantiated by the highly negative correlation coefficients of heat injury levels of leaves vs. integrated density of APX and CAT isozyme bands. This indicated that the criteria of higher expression of CATs’ and APXs’, the two major reactive oxygen species scavenging proteins in leaves may be used to screen large seedling populations and germplasm for high temperature tolerance.