Case Series of Burkholderia Pseudomallei Causing Melioidosis (Pulmonary, Cerebral, and Splenic Abscess)

Burkholderia pseudomallei is soil saprophytic Gram-negative bacilli that cause a fatal disease called melioidosis. Melioidosis is capable of causing cutaneous infection and systemic infections in the respiratory tract, cardiovascular, gastrointestinal, urinary, skin and soft tissue, and musculoskeletal and central nervous systems. Here, we report rare forms of pulmonary, cerebral, and splenic abscess case series of melioidosis caused by B. pseudomallei. Imported cases have been reported among tourists, immigrants, and soldiers who returned from endemic areas. The acquisition of infection is through percutaneous, inhalation, and ingestion of contaminated water;person-to-person transmission is very rare. Melioidosis cases are primarily found in the rainfall season and are usually associated with risk factors such as diabetes, alcoholism, and chronic renal diseases. However, 20-26% of cases were not associated with predisposing conditions. The identification is based on colony morphology, Gram stain, antibiotic susceptibility testing, and other supportive automated and molecular assays when we suspect B. pseudomallei. There are two phases, the intensive and eradication phases, in managing melioidosis. In the intensive phase, ceftazidime for 2 weeks showed efficacy in almost 50% of cases, and the eradication phase treatment with co-trimoxazole and doxycycline or amoxicillin/clavulanic acid for 3-6 months showed an excellent response. The improper clinical diagnosis and management of B. pseudomallei can lead to complications. Hence, early diagnosis with microbiological approaches such as culture, biochemical reactions, or automated systems available and antimicrobial sensitivity testing will cure the patient quickly without mortality.Copyright © 2023 The Authors.

Driving through sustainable systems: a Study of Air Quality Index of Delhi during COVID-19 Pandemic

The impact of lockdown during covid-19 pandemic on air quality in terms of pollution was investigated in the Delhi/NCR region in this study. The National Air Quality Index (NAQI) uses air quality data for six pollutant measures (PM10, PM2.5, SO2, CO, NO2 and O3) from monitoring stations across the megacity to demonstrate the spatial pattern of air quality before and during the lockdown period due to pandemic. The objective of this study is to investigate the interrelationship among the various parameters the Pearson’s correlation analysis was conducted. The results found were able to demonstrate that during lockdown air quality was significantly improved. It was also found that among other pollutants, level of NO2 and CO have also declined during- lockdown phase. It was observed that during this period of lockdown, the air quality index on maximum number of days was found to be good and satisfactory in Delhi that was the clear indication of an improvement in air quality due to a reduction in pollution and emissions of vehicles and industries. It can be implemented to further work on parameters to improve the air quality in future.

Post Covid-19 mixed fungal orbito-pansinusitis caused by Rhizopus Oryzae and Exophiala Jeanselmei-review and reports

We report a rare case of mixed fungal orbito-pansinusitis caused by Rhizopus oryzae and Exophiala jeanselmei in post-COVID-19 individuals. A 65-year-old patient was COVID-19-positive and treated as per the protocols. Following recovery after 3 weeks presents to the otorhinolaryngology outpatient department with complaints of nasal obstruction, stuffiness, pain over the maxilla, occasional fever spikes, and swelling over eyelids. He was diagnosed with a case of orbito-pansinusitis mucormycosis based on magnetic resonance imaging, nasal endoscopy, and microbiological findings. Intravenous (IV) fluconazole and amphotericin B were the conservative management initially followed by surgical debridement later. There was minimal residual deformity after patient recovery. Generally, secondary to immunosuppression or debilitating diseases leads to mucormycosis. The mode of entry for molds and spores of zygomycetes are through the respiratory tract through the nose and then reaches the sinuses, orbit, and intracranial structures. Hence, a good prognosis and to reduce morbidity by zygomycosis can be achieved by early clinical diagnosis, direct smears, and proper interventions. The diagnosis of fungal infections at the earliest is very important because the therapeutic management of fungal infection is quite challenging, especially in the case of R. oryzae and E. jeanselmei with immunocompromised state. The prophylactic drugs, steroids, and immunosuppressants for the treatment of COVID-19 should not be misused and must be used as per protocol and guidelines judiciously. © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Impact of Both the Waves of COVID-19 Pandemic on Ectopic Pregnancy in India

Aim and objective: Although two-wave pattern of the coronavirus disease-2019 (COVID-19) pandemic was observed in many countries, there is limited information on the impact of both the waves on clinical presentations of ectopic pregnancy (EP) with COVID-19. Therefore, we aimed to understand the impact of the first wave and second wave of COVID-19 pandemic on women with EPs in India. Materials and methods: We conducted a retrospective study at BYL Nair Charitable Hospital (NH), a dedicated COVID-19 tertiary care hospital in Mumbai, India. We analyzed the impact of the first wave and second wave on women with EPs and the challenges encountered for management during the pandemic in our hospital. Results: A total of 1,660 pregnant and postpartum women with confirmed diagnosis of COVID-19 were admitted at NH during the first wave and the second wave of the COVID-19 pandemic. All cases of EP were asymptomatic for COVID-19. During the prepandemic period of 4 years, there were 220 (15.2 per 1,000 births) women with EPs, which was higher compared to seven EPs (6.3 per 1,000 births) during the COVID-19 pandemic. EP rate per 1,000 births during the second wave was found to be 9.6, which is comparatively higher than the first wave (3.8) (p = 0.24). Conclusion: Increased frequency of EPs during the second wave of the COVID-19 pandemic could be due to the new variant of concern B.1.617. 2 (Delta). For ruptured EP, we recommend surgical management with laparotomy as a treatment option as it is useful in reducing the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection to healthcare workers. Clinical significance: The COVID-19 pandemic is likely to last longer and hence healthcare providers should ensure that pregnant women have access to medical assistance whenever needed. © The Author(s). 2021.

Understanding the dynamics of covid-19 outbreak: Structure, diagno-sis, prevention and treatment

Currently, mankind is fighting against an invisible enemy. The novel Coronavirus disease (COVID-19) has been spreading at a rapid rate across the world, which made the World Health Organization (WHO) to declare it as pandemic disease. COVID-19 is an acute respiratory tract infection that was first reported in December 2019, initially presented as pneumonia of un-known etiology in a group of patients in Wuhan, a city in the Hubei Province of China. Sometimes, animals infected with coronavirus infect humans and spread further via human-to-human transmission similar to the case of Middle East respiratory syndrome coronavirus (MERS-CoV), severe acute respiratory syndrome-related coronavirus (SARS-CoV), and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), previously referred to as 2019-nCoV (COVID-19). SARS--CoV-2 is an extremely pathogenic virus and is crushing the well-equipped health systems of devel-oped countries. According to the WHO situation report updated on October 25, 2020 over 42 million cases and 1.1 million deaths have been reported globally. Since the figure of cases continues to increase, these viruses create a threat to global public health. This review summarizes an overview of the study of the novel coronavirus, including origin, epidemiology, etiology, targets for viral en-try, and describes the clinical manifestation, diagnosis, and therapeutics used in clinical settings. Furthermore, our review focuses on the most up-to-date clinical information for the effective man-agement, prevention, and counseling to control COVID-19 worldwide. © 2021 Bentham Science Publishers.

Clinical Presentation of Cases with SARS-CoV-2 Reinfection/ Reactivation

Background: Reinfection/reactivation of SARS-CoV-2 has been a matter of great interest from the immunological and vaccine perspective. However, little is known about the clinical presentation of such reinfection/reactivation. We report a case series of 9 COVID-19 patients having experienced two clinically- and/or virologically-confirmed episodes of COVID-19. Methods: Epidemiological and clinical characteristics of 9 healthcare workers (HCWs) with two episodes of SARS-CoV-2 are described. Results: The incidence of reinfection/reactivation amongst the HCWs was 2% (9 out of 491) with an average remission period of 66 days (range 43-78 days). Amongst the cases of reinfection 4/9 were asymptomatic in first episode were symptomatic in second episode. There is negative correlation between numbers of days the patients took to become SARS-CoV-2 negative by RT-CPR and/or clinically recover in the first episode and the second episode irrespective for the time spent in remission. Conclusion: Shorter durations of SARS-COV-2 infection in the first episode are associated with longer time to recovery in the second episode in patients with re-infection/reactivation.

Phase I study of bendamustine, rituximab, ibrutinib, and venetoclax in relapsed, refractory mantle cell lymphoma

Introduction: Bendamustine (B) and rituximab (R) with ibrutinib (IBR) was well-tolerated and efficacious (Maddocks Blood 2015). Ibrutinib and venetoclax (VEN) were synergistic and active in relapsed, refractory (R/R) MCL (Tam NEJM 2018). VEN increases apoptotic priming and can act as a chemosensitizing agent. The aim of this phase I study was to define the safety and tolerability of VEN with BR-IBR in R/R MCL (Clinical trial: NCT03295240). Methods: Patients (pts) with R/R MCL received six 28-day cycles of BR-IBR-VEN in a 3+3 dose escalation design. Dose level 1 (DL1) included B 90 mg/m2 day (d) 1 and 2, R 375 mg/m2 d1, and IBR 560mg daily. For cycle 1, VEN dose ramp-up was 20, 50, 100, and 200mg daily weekly. During cycles 2-6, VEN 400mg daily was given d1-5. Dosing cohorts with longer duration of VEN (7d and 10d) were planned. The study was amended to include dose level-1 (DL-1) with B at 70mg/m2, d1 and 2. Results: As of March 2021, 7 pts were treated with BR-IBR-VEN at DL1 and 3 pts at DL-1. Baseline characteristics were median age 68 years (range 60-81);90% male;80% with Ki67 ≥30%;10% blastic MCL;40% TP53 mutant, and 100% one prior line of treatment (tx). One dose limiting toxicity (DLT) was observed at DL1: grade 3 thrombocytopenia lasting >14 days. At DL1, 2 pts had only 5 cycles of BR-IBR-VEN due to cytopenias (grade 3 neutropenia and grade 2 thrombocytopenia) despite B dose reduction. The frequent tx-related adverse events (AEs) were thrombocytopenia (n = 7), constipation (n = 6), fatigue (n = 4), neutropenia (n = 3), and nausea (n = 4). The grade 3-4 AEs were neutropenia (n = 1) thrombocytopenia (n = 3), and rash (n = 1). There was one tx-related serious AE: an elderly pt was briefly hospitalized during VEN ramp-up for volume overload and diuretic tx. Most pts had count recovery post-tx, but one had persistent neutropenia. Given cytopenias observed at DL1, the study was amended to include DL-1. At DL-1 (n = 3), there were no DLTs, dose reductions or delays, significant cytopenias, or ≥grade 3 txrelated AEs. The overall response rate (ORR) was 80% (8/10), all complete responses (CRs). For TP53 mutant MCL, the ORR was 50% (2/4), all CRs. There were 5 deaths (Fig 1). Two TP53 mutant MCL pts with primary refractory disease died of disease rapidly. A 17p deleted MCL pt achieved a CR and underwent allogeneic stem cell transplant and died of pneumonia (PNA) 10 mos after. A pt in CR with post-tx neutropenia died of PNA. The TP53 mutant MCL pt with a DLT after 2 cycles of BR-IBR-VEN received single-agent BTKi for 27 mos until progression and then died of COVID. Conclusions: BR-IBR-VEN showed acceptable safety and tolerability and preliminary efficacy at DL-1. During the COVID pandemic, enrollment for this immunosuppressive 4-drug regimen with intravenous tx was challenging. The study was closed after enrolling 3 of 6 pts at DL-1 and a definitive maximum tolerated dose was not determined. Future study is needed to determine the role of BR-IBR-VEN in MCL.

Prevalence, Clinical Presentations and Treatment Outcomes of COVID-19 among Healthcare Workers at a Dedicated Hospital in India

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is rapidly spreading in India and across the world. Healthcare workers (HCWs) are at increased risk of contracting COVID-19 due to direct or indirect exposure to COVID-19 patients, and require special attention. Limited information is available about its effect in HCWs. Secondary transmission from HCWs is a possibility among patients, family members, and the community. Therefore, it is important to investigate the infection risk of HCWs and the clinical characteristics of affected cases and possible source of infection with exposure details. The aim of this study is to analyze the medical records of HCWs with COVID-19 retrospectively and carry out the analysis of the data of HCWs with COVID-19 at TNMC and BYL Nair Charitable Hospital (NH, COVID-19 Hospital) in Mumbai. Interim analysis was carried out for the data collected from 6th April to 20th August 2020. Total 3711 HCWs (frontline, 74.32%, non-frontline, 25.68%) are working at NH Mumbai. We observed 11% prevalence of SARS-CoV-2 infection among HCWs, 4% co-infection and 1% mortality. Majority (85%) of the HCWs with COVID-19 were symptomatic and 15% were asymptomatic. Comorbidities were reported in 19% of HCWs with COVID-19. Hypertension and Diabetes Mellitus were the most common co-morbidities reported. More than 4% percent of HCWs with COVID-19 were also positive for plasmodium vivax Malaria. The results of the study will be useful for determining the impact of COVID-19 and adverse outcomes in HCWs, identifying probable mode of acquiring SARS-CoV-2 infection in HCWs. This is required for planning the strategies to handle the epidemic of COVID-19 among HCWs in Mumbai region, and at Maharashtra state level.

Installing oncofertility programs for common cancers in limited resource settings (Repro-Can-OPEN Study): An extrapolation during the global crisis of Coronavirus (COVID-19) pandemic.

PURPOSE: The state of limited resource settings that Coronavirus (COVID-19) pandemic has created globally should be taken seriously into account especially in healthcare sector. In oncofertility, patients should receive their fertility preservation treatments urgently even in limited resource settings before initiation of anticancer therapy. Therefore, it is very crucial to learn more about oncofertility practice in limited resource settings such as in developing countries that suffer often from shortage of healthcare services provided to young patients with cancer. METHODS: As an extrapolation during the global crisis of COVID-19 pandemic, we surveyed oncofertility centers from 14 developing countries (Egypt, Tunisia, Brazil, Peru, Panama, Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India). Survey questionnaire included questions on the availability and degree of utilization of fertility preservation options in case of childhood cancer, breast cancer, and blood cancer. RESULTS: All surveyed centers responded to all questions. Responses and their calculated oncofertility scores showed different domestic standards for oncofertility practice in case of childhood cancer, breast cancer, and blood cancer in the developing countries under limited resource settings. CONCLUSIONS: Medical practice in limited resource settings has become a critical topic especially after the global crisis of COVID-19 pandemic. Understanding the resources necessary to provide oncofertility treatments is important until the current COVID-19 pandemic resolves. Lessons learned will be valuable to future potential worldwide disruptions due to infectious diseases or other global crises.