Role of Imaging Spectrum Along With Other Diagnostic Modalities in Rhino-Orbital-Cerebral Mucormycosis (ROCM).

OBJECTIVES: Rhino-orbito-cerebral mucormycosis (ROCM), a rare angio-invasive fungal infection, had become a major outbreak during the second wave of the coronavirus disease (COVID-19) pandemic in India, with over 28,000 reported cases. The purpose of this study was to describe the imaging spectrum of ROCM, which may prove useful in prompt diagnosis, considering its grave prognosis in populations with a high load of immunosuppressed patients (e.g., COVID-19, HIV-AIDS, etc.). MATERIAL AND METHODS: Evaluation of the clinical data and imaging of patients with symptoms suspicious of mucormycosis of the craniofacial region was done. The diagnosis was made using computed tomography (CT) or magnetic resonance (MR) imaging, a biopsy, and culture. The data analysis was done using descriptive statistical methods. RESULTS: The sample group consisted of a total of 36 patients ranging from 33 years to 75 years of age, out of which 31 (86.11%) were male and five (13.8%) were female. A total of 30 (83.33%) patients had a positive correlation with COVID-19 infection, and 29 (80.55%) patients had a positive correlation with diabetes. The major presenting complaints were facial pain and swelling (20 patients; 55.55%). The intracranial spread was seen in 14 (38.88%) patients. Our study demonstrated a mortality rate of 38.88% (14 patients). CONCLUSION: ROCM, once considered to occur predominantly in diabetics, is increasingly being seen in other immunosuppressive patients, such as COVID-19. CT and MR imaging help provide an early diagnosis in conjunction with pathologic and microbiological correlations. Immediate correction of immunosuppression with the initiation of amphotericin B therapy combined with extensive and diligent surgical debridement of the diseased tissue is required.

Improvements in azithromycin recrystallization using ultrasound for size reduction.

The primary motive of the current work is to achieve smaller mean particle size with narrow size distribution that can enhance the bioavailability of azithromycin (ARZ), an essential requirement due to its poor water solubility. Recrystallization of ARZ was evaluated using cooling as well as antisolvent crystallization approaches in the presence of ultrasonic irradiation with detailed study into effect of different parameters such as ultrasonic power, time and temperature. Ultrasound assisted antisolvent crystallization at low temperatures (<10℃) yielded best size reduction up to 80% with narrower distribution and also gave better yield of the product, that too within 5 min of sonication. With scale up considerations, recirculation mode of operation was also evaluated which offered promising results for the size reduction. Images captured using optical microscope and SEM revealed a nearly uniform rod/plate-shaped geometry. Increase in amorphous nature of ARZ was confirmed based on XRD analysis. FTIR analysis showed no significant changes in the functional groups when compared to the original sample. Overall, the work demonstrated an improved reprocessing approach based on the use of ultrasound with insights into effect of operating parameters and effect of ultrasound on various characteristics.

Treatment of diaphyseal forearm fracture with interlocking intramedullary nailing: A pilot study.

INTRODUCTION: The present study was done to assess the functional outcome and complications of interlocking intramedullary (IM) radius ulna nailing to treat radio-ulna fractures in adults. METHODOLOGY: Thirty adult patients with diaphyseal or segmental fractures of radius and ulna were included and treated with IM nailing. Grace and Eversmann rating system was used to assess functional evaluation and grip strength was measured using grasp dynamometer. RESULTS: Mean age of the 30 eligible patients was 33.5 years, and males comprised 77% of the study population. Intra-operative complications like nail impaction and proximal screw locking problem for radius was present in one patient each. Increased swelling in three patients (10%) and posterior interosseous nerve palsy in one patient (3%) were observed post-operatively. In the post-operative period, all patients were able to move fingers, had 100° elbow range of motion and good grip strength. Pronation and supination till 80° was present in 80% and 57% of the patients respectively. Wrist flexion and dorsiflexion till 90° was present in 80% and 57% of the patients. Fracture union was confirmed radiologically in all cases at a mean of 3.6 weeks. Functional outcome was excellent in 73% and good in 13%. Grip strength was judged to be excellent in all cases. CONCLUSIONS: Excellent and good functional outcomes were obtained in 86%, and no case developed mal-union or delayed union. Based on our results, IM nail for surgical treatment of radial and ulnar diaphyseal fractures can be used.

Assessment of risk factors for developmental delays among children in a rural community of North India: A cross-sectional study.

BACKGROUND: Initial formative years in every children's life are critical for their optimal development, as these frame the foundation of future well-being. With a varied prevalence of developmental delays (DDs) in the world and most of the studies representing the hospital-based data. The present study was aimed to find the prevalence and risk factors for DDs (domain wise) in children aged 2 months to 6 years in the rural area of North India. METHODS: This was a cross-sectional study in which a multistage random sampling technique was used. From 30 Anganwadi centers, 450 children aged 2 months-6 years were taken in the study. Rashtriya Bal Swasthya Karyakram screening tool developed by the Ministry of Health and Family Welfare, India, was used for developmental screening. Binary logistic regression analysis was done to identify the predictors for DDs (domain wise). RESULTS: Seventy-three (16.2%) children were found to have DDs and 60 (13.3%) children had the global DDs. About 84/421 (20.0%) children had cognitive delay, followed by 43/450 (9.6%) children who had delay in speech and language area. About 17/190 (8.9%) children had social delay while 26/407 (6.4%) children had hearing and vision impairment. Gross motor delay was seen in 24/450 (5.3%) children and 16/300 (5.3%) children had fine motor delay. Gestational age (adjusted odds ratio [AOR] - 13.30), complications during delivery (AOR - 25.79), meconium aspiration (AOR - 12.81), and child never breastfed (AOR - 8.34) were strong predictors for the delay in different domains of developmental milestones. CONCLUSION: Socio-economic, ante-natal, natal and post-natal factors should be considered for prompt identification and initiation of intervention for DDs. RECOMMENDATION: There is a need for increasing awareness and knowledge of parents regarding the achievement of developmental milestones according to the age. A multipronged approach to the holistic treatment of developmentally delayed children for early intervention is required.

Development of water requirement factors for biomass conversion pathway.

Published data were used to develop an integrated spreadsheet-based model to estimate total water requirement for 12 biomass conversion pathways. The water requirement for crop production was attributed only to the grains in the estimates since agricultural residues are produced irrespective of their use for fuel or electricity. Corn stover- and wheat straw-based ethanol production pathways are water efficient, requiring only 0.3 l, whereas biopower production pathways (i.e. direct combustion and bio-oil production) require about 0.8-0.9 l of water per MJ. Wheat- and corn-based ethanol production pathways consume 77 and 108 l of water per MJ, respectively. Utilization of switchgrass for production of ethanol, biopower through the direct combustion, and pyrolysis consume 128, 187 and 229 l of water per MJ, respectively. Biodiesel production from canola seed consumes 124 l of water per MJ. Corn stover- and wheat straw-based conversion pathways are most water efficient.