The Fragile Patient: Considerations in the Management of Invasive Mould Infections (IMIs) in India.

Invasive mould infections (IMIs), which are mostly caused by Aspergillus spp. and Mucormycetes, are opportunistic infections that impose a substantial threat to patients who are considered to be 'fragile'. There is no fixed definition for fragile patients; however, patients with cancer or acquired immunodeficiency syndrome (AIDS), patients who have undergone organ transplants, and patients being treated in the intensive care units (ICUs) were considered fragile. Management of IMIs in fragile patients is challenging, owing to their compromised immune status. The diagnostic challenges associated with IMIs due to insufficient sensitivity and specificity of the current diagnostic tests lead to delayed treatment. A widening demographic of at-risk patients and a broadening spectrum of pathogenic fungi have added to the challenges to ascertain a definite diagnosis. A recent surge of mucormycosis associated with SARS-CoV-2 infections and the resultant steroid usage has been reported. Liposomal amphotericin B (L-AmB) is the mainstay for treating mucormycosis while voriconazole has displaced amphotericin B as the mainstay for treating Aspergillus infection due to its better response, improved survival, and fewer severe side effects. The selection of antifungal treatment has to be subjected to more scrutiny in fragile patients owing to their comorbidities, organ impairment, and multiple ongoing treatment modalities. Isavuconazole has been documented to have a better safety profile, stable pharmacokinetics, fewer drug-drug interactions, and a broad spectrum of coverage. Isavuconazole has thus found its place in the recommendations and can be considered a suitable option for treating fragile patients with IMIs. In this review, the authors have critically appraised the challenges in ascertaining an accurate diagnosis and current management considerations and suggested an evidence-based approach to managing IMIs in fragile patients.

Effect of Covid-19 on nasal allergies: A study from hilly regions of Himachal Pradesh

Background: The World Health Organization (WHO) designated SARS-CoV-2 infection as coronavirus disease 2019 (Covid-19).Due to the government implication of Covid-19 specific guideline of using mask, there could be a significant decrease in the allergic rhinitis. Objective(s): Present study aims to analyze the changes in the trends of nasal allergies from hilly regions of Himachal Pradesh following Covid-19 pandemic. Method(s): The prospective data obtained from January 2022 to November 2022 was compared from the retrospective data available between January 2019 to November 2019. Prospectively, a total of 596 patients were included in the study. All these patients underwent Skin prick tests for common allergens. All these patients also underwent testing for total IgE levels in biochemistry lab of the hospital by chemiluminescence method.The results were compared with retrospective dataof 728 age sex match patients. Result(s): A significant difference in the allergen sensitivity was observed. The number of patients who were sensitized during Covid was comparatively less than those during Pre covid period.Dust mite, Cockroach, Peanut and Wheat revealed a non-significant odds ratio indicating that they were not true predictors for sensitization and non-sensitization. Whereas Grass pollen, Mould mix and Pine mix revealed a significant odds ratio. Usage of mask found to have an impact on improvement in symptoms. Majority of the patients who did not use mask had no improvement in symptoms. Majority of the patients had high IgE levels in pre covid period whereas it was normal for majority of them during covid. Conclusion(s): In our study, allergic rhinitis incidence decreased throughout the pandemic period. After pandemic, there was a noticeably decreased level of sensitivity to grass pollen, mould, and pine mix. Use of face masks lead to significant decrease in symptoms of allergic rhinitis.Copyright © 2022, Anka Publishers. All rights reserved.

Development Of Technology for Obtaining Natural Nutriceutics in Solid Form

This article discusses development of technology for obtaining natural nutriceutics in solid form. Currently, a healthy lifestyle, a healthy diet and the body's resistance to external negative factors have become topical issues, especially after the outbreak of the global COVID-19 pandemic. Basically, the prevention and treatment of diseases occurs due to the replenishment of the complex of bioactive substances that the body receives from healthy food. Otherwise, if the tissues and organs do not receive the elements necessary for the normal functioning of the body, then the strength to fight the disease decreases. Here, dietary supplements, that is, nutraceuticals, play an important role, they are consumed with food and are mainly obtained from products of natural origin: vegetable, animal and bacterial.Copyright © 2023, Codon Publications. All rights reserved.

The effect of current infection control procedures and application times on the dimensional stability of dental impression materials

Aims: In this study, the effects of different disinfection and sterilization methods and their application duration on the dimensional stability of impression materials were evaluated. Methods: Two impression materials, condensation (CS) and addition silicone (VPS), disinfectants with 5.25% sodium hypochlorite (NaOCl) immersion, 3% hydrogen peroxide immersion and steam autoclave were selected. Disc-shaped samples (n=112) were obtained in 7 subgroups of each material (n=8). Sixteen untreated samples served as controls. Dimensional change was measured with a digital micrometer in the reference lines on the sample. Results: The highest mean percentage of dimensional change for the 50 min autoclave was 0.10±0.03% for CS and 0.10±0.02% for VPS. The dimensional change in CS did not differ for hydrogen peroxide. Compared with the controls, dimensional change was significant in 20 min NaOCl and 50 min autoclave (p<.05). Both impression materials in the autoclave showed statistically significant dimensional changes regardless of the time. The difference in application duration significantly affected the dimensional stability of the impression materials regardless of the procedure (p<.001). Extended application duration did not affect the dimensional stability in the hydrogen peroxide for CS, NaOCl and autoclave for VPS. Conclusions: Chemical disinfection and autoclave sterilization caused statistically significant but clinically acceptable dimensional changes in CS and VPS impression materials used in this study.

Intelligent IoT-BOTNET attack detection model with optimized hybrid classification model

The botnet have developed into a severe risk to Internet of Things (IoT) systems as a result of manufacturers ‘insufficient security policies and end users' lack of security awareness. By default, several ports are open and user credentials are left unmodified. ML and DL strategies have been suggested in numerous latest research for identifying and categorising botnet assaults in the IoT context, but still, it has a few issues like high error susceptibility, working only with a large amount of data, poor quality, and data acquisition. This research provided use of a brand-new IoT botnet detector built on an improved hybrid classifier. The proposed work's main components are "pre-processing, feature extraction, feature selection, and attack detection." Following that, the improved Information Gain (IIG) model is used to choose the most reliable characteristics from the received information. To detect an attack, a hybrid classifier is utilized which can be constructed by integrating the optimized Bi-GRU with the Recurrent Neural Network (RNN). To increase the detection accuracy of IoT-BOTNETS, a novel hybrid optimization approach called SMIE (Slime Mould with Immunity Evolution) is created by conceptually integrating two conventional optimization modes: Coronavirus herd immunity optimizer (CHIO) and the Slime mould algorithm. The final output of the hybrid classifier displays the presence or absence of IoT-BOTNET attacks. The projected model's accuracy is 97%, which is 22.6%, 18.5%, 27.8%, 22.6%, and 24.8% higher than the previous models like GWO+ HC, SSO+ HC, WOA+ HC, SMA+ HC, and CHIO+ HC, respectively. © 2022

Coronavirus disease 2019-associated mucormycosis of the head-and-neck area: A new rise of dreaded black fungus in the current pandemic

Coronavirus disease 2019 (COVID-19) pandemic is currently evolving and associated with more complications with invasive fungal infection like mucormycosis. Classically, uncontrolled diabetes mellitus (DM) and other immunosuppressive conditions like corticosteroid therapy are known risk factors for causing mucormycosis in COVID-19 patients. Mucormycosis is an invasive fungal infection which rapidly spread to the orbit and brain from the nasal cavity and paranasal sinuses. Mucormycosis in COVID-19 is a fatal to the patient. There is possibility of COVID-19 as a trigger factor for diabetic ketoacidosis which predisposes to invasive fungal infections such as mucormycosis. Patients with poorly controlled DM and immunocompromised conditions increase the risk for development of COVID-19 infections in COVID-19 patients. During the current COVID-19 pandemic, a myriad of clinical manifestations and complications are emerged. Rhino-orbital-cerebral mucormycosis is a fatal clinical entity associated with COVID-19 infections resulting in higher morbidity and mortality. The treatment includes both medical and surgical interventions. It requires early and adequate treatment with amphotericin B and surgical debridement and control of risk factors. A multidisciplinary approach by otorhinolaryngologists, ophthalmologists, neurologists, and dentists is successful for treatment of COVID-19 patients with mucormycosis in the head-and-neck region. Identification of the risk factors and early preventive measures will minimize the incidence of life-threatening mucormycosis in the head-and-neck area of COVID-19 patients.

Agents of mucormycosis outbreak associated with COVID-19

Mucormycosis is a life-threatening infection. Mucormycetes causes a wide range of diseases, including pneumonia, rhinosinusitis, internal organ spread, gastrointestinal tract involvement, and skin and soft tissue infection. It infects predominantly with hematological malignancies, transplantation, immunocompromised, and diabetes mellitus patients. The most severe type of the disease is a disseminated disease, which is linked to significant immunosuppression. Currently, this disease is more prevalent in the COVID-19 pandemic because of erroneous steroid use and untreated diabetes. However, there is a scarcity of study and information on the COVID-19 and mucormycosis connection. According to the latest research, mucormycosis cases are rising in developed and developing nations, and only a few therapies are available. The exact burden of mucormycosis is unclear;however, it is likely to be greater than recorded instances due to mucormycosis epidemiological changes. As a result of the delay in identifying this severe illness, appropriate antifungal medications are delayed, resulting in significant morbidity and death. A few drugs are underclinical trials for their efficacy. Other obstacles to treat patients are lack of reliable diagnostic non-invasive tests. This review article draws the attention of its readers and clinicians towards the agents of mucormycosis and discuss the various cases to manage this fungal infection.

Assessment of Possibilities of Spreading of Bioaerosol from Different Technological Objects in Small Sewage Treatment Plants

The Covid-19 pandemia increased the attention of the world community to air biocontamination. Sewage treatment plants (STPs) generate a bioaerosol during different technological operations. Research aimed to estimate the range of bioaerosol emission from different technological objects of 5 small STPs. Such knowledge is very important for risk assessment, monitoring programs and pollution limitation. The sedimentation method was used for the detection of mesophiles, psychrophiles, Escherichia con, pigmented bacteria, Streptococcus faecalis, Pseudomonas fluorescens, and mold fungi. The highest level of psychrophiles and mold fungi (> 1000 cfu/m(3)) was detected in points located near activated sludge chambers, sludge thickening tanks, and secondary clarifiers. The mesophiles (>500 cfu/m(3)) and E. coli aren't a normal component of air microflora, but were detected in all measurement points, especially near a pomp station (inflow), grit, activated sludge, sludge thickening chambers. At the points located at the leeward, the number of microorganisms was higher than in the windward. The research results indicate the necessity of constant monitoring of the STP impact on the air quality.

Antibacterial, Antifungal and Antiviral Polymeric Food Packaging in Post-COVID-19 Era.

Consumers are now more concerned about food safety and hygiene following the COVID-19 pandemic. Antimicrobial packaging has attracted increased interest by reducing contamination of food surfaces to deliver quality and safe food while maintaining shelf life. Active packaging materials to reduce contamination or inhibit viral activity in packaged foods and on packaging surfaces are mostly prepared using solvent casting, but very few materials demonstrate antiviral activity on foods of animal origin, which are important in the human diet. Incorporation of silver nanoparticles, essential oils and natural plant extracts as antimicrobial agents in/on polymeric matrices provides improved antifungal, antibacterial and antiviral properties. This paper reviews recent developments in antifungal, antibacterial and antiviral packaging incorporating natural or synthetic compounds using preparation methods including extrusion, solvent casting and surface modification treatment for surface coating and their applications in several foods (i.e., bakery products, fruits and vegetables, meat and meat products, fish and seafood and milk and dairy foods). Findings showed that antimicrobial material as films, coated films, coating and pouches exhibited efficient antimicrobial activity in vitro but lower activity in real food systems. Antimicrobial activity depends on (i) polar or non-polar food components, (ii) interactions between antimicrobial compounds and the polymer materials and (iii) interactions between environmental conditions and active films (i.e., relative humidity, oxygen and water vapor permeability and temperature) that impact the migration or diffusion of active compounds in foods. Knowledge gained from the plethora of existing studies on antimicrobial polymers can be effectively utilized to develop multifunctional antimicrobial materials that can protect food products and packaging surfaces from SARS-CoV-2 contamination.

Production scheduling optimization for parallel machines subject to physical distancing due to COVID-19 pandemic

This paper, for the first time, presents a production scheduling model for a production line considering physical distancing between the machines' workforces. The production environment is an unrelated parallel-machine, in which for producing each part, different machines with different production rates and the required number of workers are available. We propose a three-objective mixed-integer linear programming mathematical model that aims to maximize the manufacturer's total benefit, parts' safety stock (SS) index, and the workforce's physical distance over a finite horizon (one year) by determining the optimal scheduling of the parts on the machines. Since a large production scheduling problem belongs to the Np-Hard category of problems, a non-dominated sorting genetic algorithm, and a non-dominated ranked GA algorithm are developed to solve the presented model in two stages using the empirical data from a Canadian plastic injection mold company. In the first stage, the LP-metrics approach is utilized for validating the meta-heuristics on a reduced-size problem. In the second stage, the validated meta-heuristics are utilized to optimize the company's yearly production schedule. The results indicate both metaheuristics are performing well in determining the optimal solution. Moreover, implementing physical distancing in the company reduces the company's monthly net benefit by around 9.56% compared to the normal operational conditions (without considering physical distancing).

Impacts of Air Pollution and Dampness on Occupant Respiratory Health in Unplanned Houses: A Case Study of Bandung, Indonesia

This paper presents the results from field measurements and household surveys on the severity of indoor mold risk and its impact on respiratory health in a typical unplanned neighborhood of kampungs in Bandung, Indonesia. Mold risk was investigated using fungal risk detectors (n = 102), while air pollution levels were established with total suspended particulate (TSP) and particulate matter (PM2.5) (n = 38). The self-reported prevalence of respiratory diseases was obtained using a questionnaire form (ATS-DLD-78) (n = 599). The results showed that respiratory health problems were higher in the rainy season, particularly among children. Most houses suffered from severe mold risk, primarily due to extreme humid weather conditions, especially during rainy season (97%) where water leakage was prevalent (60%). In addition, the TSP and PM2.5 concentrations exceeded the WHO standards in most kampung houses, where around 58% of the houses recorded higher outdoor mean PM2.5 concentrations than indoors. Further, the path analysis showed that allergies followed by humidity rate and smell, which were affected by window-opening duration, directly impacted children’s respiratory health. Smoking behavior and building-related health problems, due to exposure to outdoor air pollution, affected the respiratory health of those aged 15 years old and over.

The emergence of COVID-19 associated mucormycosis: a review of cases from 18 countries

Reports of COVID-19-associated mucormycosis have been increasing in frequency since early 2021, particularly among patients with uncontrolled diabetes. Patients with diabetes and hyperglycaemia often have an inflammatory state that could be potentiated by the activation of antiviral immunity to SARS-CoV2, which might favour secondary infections. In this Review, we analysed 80 published and unpublished cases of COVID-19-associated mucormycosis. Uncontrolled diabetes, as well as systemic corticosteroid treatment, were present in most patients with COVID-19-associated mucormycosis, and rhino-orbital cerebral mucormycosis was the most frequent disease. Mortality was high at 49%, which was particularly due to patients with pulmonary or disseminated mucormycosis or cerebral involvement. Furthermore, a substantial proportion of patients who survived had life-changing morbidities (eg, loss of vision in 46% of survivors). Our Review indicates that COVID-19-associated mucormycosis is associated with high morbidity and mortality. Diagnosis of pulmonary mucormycosis is particularly challenging, and might be frequently missed in India.

CLINICAL STUDY OF COVID ASSOCIATED RHINO-ORBITAL MUCOR MYCOSIS IN STATE COVID HOSPITAL

Background: Mucormycosis is one such infection which has shown a sudden rise during the second wave in India. (Our present study has been designed to all the confirmed cases of rhino orbital mucormycosis. In our study we have included all the rhinorbital mucormycosis cases that have been confirmed by microscopy and or radiological evidence.Mucormycosis (also called zygomycosis) is a serious fungal infection caused by agroup of molds called mucoromycetes. Materials and Methods: All the patients that have directly attended the ophthalmology OPD. Chief complaint with duration (Look for redness, watering, discharge & pain in the eye, diplopia, eyelid/ periocular swelling) facial swelling, eyelid/perioculay facial discoloration, Worsening headache, sudden drooping of eyelid (or) restricted eye movements, sudden loss of vision, facial parasthesia / anaesthesia, nasal discharge (blakish/ bloody/foul smell nasal stuffiness, dental pain. Results: Out of all 60 cases, 79 there were 47 males and 13 females. In this study 48.33% cases belongs to age group of 50-60 years followed by 36.66% belongs to age group of 60-70 years. Among the 60 patients who presented to hospital within 1 week of onset of symptoms likee pain redness watering et 35 of them got good vision, whereas among the 15 members who presented beyond 2 weeks after the onset of their symptoms only 7 got good vision while 2 of them got poor vision below 6/60 indicating the importance of early diagnosis. 65% cases affected at right eye and 63.33% cases showing symotoms like Redness, treatment under goes with total Restriction 42 members and Painful oculr movement in 43.33% cases. Conclusion: The second wave of COVID-19 in India has led to more deaths than the first. In just a few weeks, the B.1.617.2 (Delta) variant became the dominant strain across India. It has since spread to about 40 nations, which include United Kingdom, Fiji and Singapore.18 the first case of Covid-19-related Mucormycosis has now been found in Chile. It is important to recognise at an early stage this infection, so as to potentially reduce soft and hard tissue necrosis and severe complications and alert colleagues of this mutilating and life threatening infection.

OUTCOMES OF FUNGAL INFECTIONS IN COVID-19 ADMISSIONS

BACKGROUND: COVID-19 has increased awareness of fungal infections among hospitalized patients. With the use of multiple immune-modulating drugs in COVID-19 along with COVID-19 related immune suppression, the risk of fungal infections is high. We studied fungal infections in COVID-19 to identify patterns to aid in preventive measures. METHODS: We included all COVID-19 positive adult patients (≥18 years) hospitalized between March 1, 2020, to October 1, 2021. Fungal infections were deemed positive if they developed fevers, leukocytosis along with positive cultures (blood, respiratory or urine). Candida albicans was considered to be causative if either blood cultures were positive or positive cultures from 2 sites and antifungals were administered. Outcomes studied were rates, organisms involved, and in-hospital mortality. We used multivariable logistic regression models to examine characteristics associated with the development of fungal infections. Variables used in the model included patient demographics (age, gender, race), comorbidities (congestive heart failure, diabetes mellitus, chronic obstructive pulmonary disease, end- stage renal disease, cirrhosis, and cancer), medications used to treat COVID-19 (ivermectin, hydroxychloroquine, steroids, tocilizumab, baricitinib), the severity of disease (4C score, use of invasive mechanical ventilation (IMV), acute kidney injury (AKI) requiring hemodialysis), and presence of central venous catheters. RESULTS: Of 7508 admissions with COVID-19, 82 (1.1%) acquired fungal infections. Fungal infections developed in 61(3.7%) of the 1642 intensive care unit (ICU) admissions and 21 (0.4%) of the 5866 non-ICU admissions. Among the fungal infections - 33 were Candida albicans, 28 were non-candida albicans, 19 were molds and 2 were cryptococcus. Fungal infections were associated with the use of IMV (Odds Ratio (OR) 13.3, 95% confidence interval (CI) 6.7-26.3, p<0.001), steroids (OR 2.4, 95%CI 1.6- 3.6, p<0.001), and AKI requiring hemodialysis (OR 2.2, 95%CI 1.2-4.1, p=0.01). Of the 5866 non-ICU admissions, in-hospital mortality was significantly higher in those with fungal infections (65% vs 7.3%, p< 0.001). Similarly, among the 1642 ICU admissions, in-hospitalmortality was significantly higher in those with fungal infections (64% vs 37%, p<0.001). On logistic regression analysis, fungal infections were associated with higher in-hospital mortality (OR 2.0;95%CI 1.1- 3.6, p=0.03). Of the fungal infections, molds were associated with higher in-hospital mortality (OR 4.4, 95%CI 1.2- 16.4) while Candida albicans (OR 2.4, 95%CI 0.9-6.4, p=0.08) and non-albicans candida (OR 1.2, 95%CI 0.5-3.3, p=0.66) did not reach significance. CONCLUSIONS: Fungal infections are rare in hospitalized COVID-19 patients but ten times more common in ICU admission. Fungal infections were associated with IMV, steroids, and AKI requiring hemodialysis. Molds were associated with higher in-hospital mortality.

COVID-19 AND MUCORMYCOSIS: A SHORT REPORT FROM INDIA

Many complications and symptoms were documented on COVID-19 patients in the second-phase of the COVID-19 outbreak in India. Patients with COVID-19 are already of increased risk of pulmonary embolism (PE), acute cardiac injury (ACI), arrhythmias, and a variety of additional consequences such as altered mental status and proptosis. Mucormycosis, a fungal infection produced by a type of moulds known as mucormycetes, was discovered in a COVID-19 patient. It is a very rare and serious fungal infection (Black Fungus). Mucormycosis, one of the most rapidly spreading infections in COVID-19 patients, has been recorded in 11,717 cases in India. Molds dwell in the environment and primarily affect people who have a weak immune system. Inhaling pathogenic organisms from the air usually causes it to harm the sinuses and lungs. COVID-19 individuals have immunosuppressive with significant drop in CD4+T and CD8+T cells, in addition to alveoli damage and severe pulmonary inflammation. As a result, severely ill-patients, particularly those sent in the intensive-care-unit (ICU) and requiring mechanical ventilation, or those with extended hospital stays 40 to 50 days were more susceptible to mucormycosis. Further, it is crucial to find out that COVID-19 patients especially the ones who are severely ill resulting in weaker immune system can further develop a fungal infection during the middle and or latter stages of COVID-19.

COVID-19-Associated Mucormycosis: An Opportunistic Fungal Infection. A Case Series and Review.

BACKGROUND: A surge in COVID-19-associated mucormycosis cases has been observed during the second wave of COVID-19 in summer of 2021. Most cases were reported from India. The Delta variant (B.1.617.2) was the most common variant circulating at that time. Mucormycosis is an opportunistic angioinvasive fungal infection with high morbidity and mortality. METHODS: We present 10 cases of COVID-19-associated rhino-orbital and rhino-orbital-cerebral mucormycosis managed in a secondary hospital in Oman. RESULTS: The median time for developing mucormycosis was two weeks after COVID-19 diagnosis. All patients were newly diagnosed or already known to have poorly controlled diabetes mellitus. Five patients received corticosteroid therapy for COVID-19. Three patients had severe COVID-19 and died of severe acute respiratory distress syndrome and septic shock. Another three patients died of advanced mucormycosis and cerebral involvement. Despite aggressive medical and surgical intervention, the mortality rate was 60% (6/10). CONCLUSION: Mucormycosis is an aggressive opportunistic infection with high morbidity and mortality that requires prompt recognition and urgent intervention. Uncontrolled blood sugar, the use of corticosteroids, and immune dysfunction due to COVID-19 are all important risk factors for development of mucormycosis. Worse outcomes are associated with poor glycemic control despite aggressive medical and surgical interventions.

COVID-19 associated mixed mold infection: a rare case report of aspergillosis and mucormycosis

Background: Fungal epidemic was announced amid COVID pandemic with several cases of COVID-associated Mucormycosis and Aspergillosis being reported however there is not sufficient data regarding mixed fungal infection. Case Study: A 54-year-old male patient diagnosed with severe COVID 19 pneumonia and diabetes 1-month back presented to OPD with C/O of chest pain and breathlessness for two days associated with haemoptysis, heaviness and congestion of right nostril but no fever. O/E patient was tachypnoeic, hypoxic and in shock, Neutrophil count 87%, RBS-530 mg/dl, urine ketone body was absent. Chest x-ray showed opacity over the left upper and mid-zone, HRCTthorax showed a bird-nest-sign noted in the left upper lobe S/O invasive fungal infection. MRI PNS showed mucosal thickening S/O sinusitis, Fungal infection. Sino-nasal mucosa KHO-mount and fungal culture showed mixed infection of Rhizopus species and aspergillus flavus. Right nasal HP study showed mixed invasive moulds infection. Initially, the patient was treated conservatively later on inj. amphotericin-B was started. The patient's condition worsened on day-18 and succumbed a day later. Discussion: Uncontrolled diabetes-mellitus, and corticosteroids leading to hyperglycaemia, extensive use of broad-spectrum antibiotics increases the risk of invasive Moulds. In our case study, patients suffered from COVIDpneumonitis and had uncontrolled diabetes leading to damage of airway epithelium inviting an invasion of tissues by moulds. Conclusion: Mixed fungal infections as COVID-19 sequelae may be an emerging issue and seen particularly in post- COVID patients with uncontrolled diabetes, and on steroids. The focus should be on prompt management: hit hard approach with both medical and surgical treatment.

Epoxy Resin as Mounting Medium- A Novel Method for Teaching and Learning

Introduction: Anatomy Museum is an indispensable part of a medical college since it gives complete knowledge of the human body in its four walls. It not just displays meticulously and painstakingly prepared prosections of different body parts and organs but also includes many other teaching aids. Aim: The aim of the study is to use epoxy resin to mount specimens for anatomy museum and also to overcome the difficulty in traditional mounting methods. Materials and Methods: Epoxy resin mixture with hardener, fresh goat kidney, and liver plastic mould and Perspex/glass jar was used. Introduction: In 2019, COVID-19 originated from China and rapid spread throughout globe. Transmission of SARS-CoV-2 is high as a result;WHO and countries worldwide have imposed rigorous public health concern, such as lockdown and social distancing. This results the closure of educational institutes globally. Since the outbreak of COVID-19, paramedical institutes have sought ways to shift from traditional teaching to virtual teaching. Aim: The aim of this study was to determine the perception of 1st year paramedical students and to analyze the merits and demerits of virtual learning during the COVID-19 pandemic. Materials and Methods: A descriptive cross-sectional study was conducted at Sri Ramachandra Medical College and Research Institute, Chennai for Paramedical courses Microbiology, BSc sports science and BSc Speech therapy courses. Phase -I students participated in this study with a sample size of 400. A self-designed The fresh specimens were mounted using epoxy resin and allowed for curing. Result: The result obtained was a crystal-clear epoxy resin mounted specimen. The demonstrator as well as the students may feel comfortable and easy to handle as well as to teach and learn. Conclusion: The greatest advantage of this technique was it can be stored and maintained for a long time in the museum without forming any discolouration and dusting of the mounted specimens.

Successful treatment of disseminated Verruconis gallopava infection in a heart transplant recipient: A case report.

PURPOSE: To describe a case of disseminated Verruconis gallopava infection in a cardiac transplant recipient that was successfully treated with oral posaconazole and intravenous anidulafungin. SUMMARY: A 51-year-old male initially presented with pulmonary manifestations, but subsequently developed cutaneous lesions, fungemia, osteomyelitis of the hip requiring excision, and eventually brain abscesses over the course of 3 months. The patient was successfully treated with various antifungal agents throughout his treatment course and was eventually discharged on oral posaconazole and intravenous anidulafungin. He remained on oral posaconazole suppressive therapy and had had no recurrence of fungal infection after 31 months of follow-up. CONCLUSION: On the basis of this case report, intravenous anidulafungin and chronic suppressive therapy with oral posaconazole can successfully treat disseminated V. gallopava infections.