Prevalence, predictors, and outcome of pulmonary mucormycosis in COVID-19 associated rhino orbital mucormycosis in a tertiary care center in South India.

Background and Purpose: India witnessed an explosive rise in mucormycosis following COVID-19 infection. Pulmonary mucormycosis closely followed rhino orbital mucormycosis as the most common presentation. The need for advanced resources and lack of clinical suspicion for COVID-19-associated pulmonary mucormycosis led to widespread underdiagnosis and poor response to late therapy. The present study aimed to assess the prevalence of pulmonary mucormycosis in COVID-19-associated rhino-orbital mucormycosis using non-invasive techniques, such as sputum microscopy and chest imaging. Materials and Methods: A prospective observational study was conducted at the Institute of Internal Medicine, Rajiv Gandhi Government General Hospital in Chennai, India between June 2021 and July 2021. All hospitalized patients with proven rhino orbital mucormycosis with or without cerebral involvement within three months of confirmed COVID-19 infection who had clinical symptoms compatible with pulmonary mucormycosis were included in this study. These patients were screened for probable and possible COVID-19-associated pulmonary mucormycosis using computed tomography (CT) chest imaging and sputum microscopy within 48 h of hospital admission. Results: Based on the findings, 8 (16%) out of 50 patients with rhino-orbital mucormycosis, had associated possible or probable pulmonary mucormycosis. All 8 patients were diabetics and had characteristic CT chest findings while only half of them had positive sputum microscopy. A higher prevalence of probably disseminated COVID-19-associated mucormycosis was noted among 51-60-year-old males with the use of corticosteroids and oxygen for COVID-19 therapy. The mortality rate was 100% in probably disseminated mucormycosis, 50% in possible disseminated mucormycosis, and only 9.5% in isolated rhino-orbital mucormycosis. Conclusion: Non-invasive and feasible methods, such as sputum microscopy and chest imaging can be considered for early screening and intensive management of probably disseminated mucormycosis to improve prognosis.

Effect of mitochondrially targeted carboxy proxyl nitroxide on Akt-mediated survival in Daudi cells: Significance of a dual mode of action.

Vicious cycles of mutations and reactive oxygen species (ROS) generation contribute to cancer progression. The use of antioxidants to inhibit ROS generation promotes cytostasis by affecting the mutation cycle and ROS-dependent survival signaling. However, cancer cells select mutations to elevate ROS albeit maintaining mitochondrial hyperpolarization (Δψm), even under hypoxia. From this perspective, the use of drugs that disrupt both ROS generation and Δψm is a viable anticancer strategy. Hence, we studied the effects of mitochondrially targeted carboxy proxyl nitroxide (Mito-CP) and a control ten carbon TPP moiety (Dec-TPP+) in the human Burkitt lymphoma cell line (Daudi) and normal peripheral blood mononuclear cells under hypoxia and normoxia. We found preferential localization, Δψm and adenosine triphosphate loss, and significant cytotoxicity by Mito-CP in Daudi cells alone. Interestingly, ROS levels were decreased and maintained in hypoxic and normoxic cancer cells, respectively, by Mito-CP but not Dec-TPP+, therefore preventing any adaptive signaling. Moreover, dual effects on mitochondrial bioenergetics and ROS by Mito-CP curtailed the cancer survival via Akt inhibition, AMPK-HIF-1α activation and promoted apoptosis via increased BCL2-associated X protein and poly (ADP-ribose) polymerase expression. This dual mode of action by Mito-CP provides a better explanation of the application of antioxidants with specific relevance to cancerous transformation and adaptations in the Daudi cell line.

Perception of pharmacists regarding over-the-counter medication: A survey.

OBJECTIVE: To assess knowledge, attitude, and practice of the pharmacists toward dispensing the over-the-counter (OTC) medications using questionnaire. MATERIALS AND METHODS: cross-sectional questionnaire-based study was conducted to assess the knowledge, attitude, and practice among pharmacists regarding OTC medications. Eighty out of hundred filled questionnaires were received from various pharmacists from medical shops in and around Kolar. Data were analyzed using descriptive statistics. RESULTS: A total of 74.6% responded to the questionnaire. Most of the dispensers (97.3%) at pharmacy were qualified with a D.Pharma/B.Pharma degree. Pharmacists with B.Pharma (80%) were able to define OTC. Majority of them had more than ten consumers taking OTC per week. Among the OTCs dispensed, common were analgesics (75%), antacids (48%), antihistaminics (40%), and others (35%). The choice of OTC brand was made by pharmacists (58.7%) and consumers (41.2%). Most of them (96.5%) asked the consumer's complaints before dispensing the drug, but only few (51%) counseled them regarding the instructions to administer medication. The brand of OTC was influenced by prescriptions of local doctor (60%), consumer's choice (31.2%), cost of the drug (16.7%), and medical representatives (5%). OTCs were safe to dispense, according to 90% of the pharmacists; however, among them, 50% expressed that the consumers should first consult doctor. CONCLUSION: Majority of the pharmacists were qualified to dispense medication, but only few knew about OTC drugs. Analgesics were most commonly used OTC. These drugs were safe to dispense, however, consulting doctor before taking medications was suggested by some of them.