Post-Covid-19 Rhino-Cerebral Mucormycosis: an Observational Study During the Second Wave.

Mucormycosis is one of the most lethal and rapidly spreading fungal infection which is caused by fungus of the order Mucorales. The swiftness of spreading and high mortality rate that characterize mucormycosis cases added more burden to the enormous challenge brought by the Covid-19 pandemic globally. The aim of this article is to identify and discuss mucormycosis and review the literature related to its diagnosis and management. A total of 15 mucormycosis cases with a history of Covid-19 infection were identified in the Department of Dentistry of Shri B M Patil Medical College Hospital and Research Centre BLDE (Deemed to be University), Vijayapura, India. The duration of the study was between April 1st and mid-September 2021. Nasal swab and tissue samples from oral and maxillofacial region were collected. Blood investigations, RT-PCR and HbA1c tests and radiography revealed changes in the trabecular pattern and bone loss associated with periodontal inflammation. Mucormycosis is a life-threatening infection. Hence, dental and other clinical professionals must be aware of this possible fatal complication, so as to avoid an unfavorable outcome in clinical practice.

Anatomical Variations of the Suprascapular Notch and its Importance in Suprascapular Entrapment Neuropathy.

Background: Anatomical knowledge about the suprascapular notch is very important in understanding the risk of suprascapular nerve entrapment syndrome. Suprascapular nerve injuries have become commonly recognized as a cause of shoulder pain and dysfunction. This study aimed to describe the morphometrical influence of the suprascapular notch on the course of the suprascapular nerve. Method: A total of 138 dry human scapulae of both sides of the unknown sex were used. Four measurements were defined and collected for every suprascapular notch: maximum depth (MD), superior transverse diameter (STD), middle transverse diameter (MTD), and total circumferential diameter (TCD). Result: In the present study we found different shapes of suprascapular notches. Out of 138 scapulae, 67 (48.55%) had U-shaped notch, 29 (21.01%) V-shaped notch and 14 (10.14%) J-shaped notch. Nine (6.52%) scapulae had incomplete notch. Two (1.44%) scapulae had large double foramen. Six (4.34%) scapulae had complete suprascapular notch. In seven (5.07%) scapulae, the notch was absent. Interestingly, in two (1.44%) scapulae, we found a W-shaped notch. This observation was unique and not reported anywhere in the literature before. Conclusion: Anatomical knowledge about the morphology of the suprascapular notch is of extreme importance for clinicians, radiologists, neurosurgeons, and orthopedic surgeons in making a proper diagnosis and for planning the surgical procedures of the shoulder region.

A Morphometric and Radiological Study of Sacral Hiatus in Human Adult Sacra and Its Clinical Relevance in Caudal Epidural Anaesthesia.

Background: The knowledge of sacral hiatus anatomy is crucial in clinical situations requiring caudal epidural block for various diagnostic and therapeutic procedures of the lumbosacral spine to avoid complications and failure rate. This study was undertaken to compare morphometric characteristics of sacral hiatus in human dry sacra and pelvic radiographs for placing the needle more accurately in the sacral hiatus landmarks to permit correct, painless, and uncomplicated caudal epidural accesses. Materials and methods: The present study was done on 138 human adult dry sacra and 110 anteroposterior lumbosacral spine radiographs of the North Karnataka region of India. Sacral hiatus was evaluated in each sacrum based on its shape, level of its apex, and base according to sacral and coccygeal vertebrae, length, anteroposterior diameter at its apex, and transverse width at its base. Results:The mean length of sacral hiatus in men and women was 27.81+1.17 mm and 24.73+2.21 mm, respectively. The mean anteroposterior diameter of the sacral hiatus at the apex was 6.24+2.73 mm in males and 6.63+2.81 mm in females. The transverse width of the sacral hiatus at the base was 17.56+1.81 mm in males and 17.92+2.59 mm in females. The location of the apex of sacral hiatus was the highest in number at the level of the fourth sacral vertebra (23.63%). The location of apex in radiographs of all lumbosacral spine S3 showed 49.09% maximum. The location of the base of the sacral hiatus was observed in the dry sacra at the level of the fifth sacral vertebra (64.54%). In the present study, different shapes of the sacral hiatus were recorded. The most common shape in males and females was inverted U shape (42.02%), followed by inverted V shape (26.08%) and dumbbell shape (12.31%). The least common shape was observed in the bifid sacra (5.07%). In 2.17% of cases, sacral hiatus was absent. Percentage of absence, agenesis, irregular, and bifid shapes were found rather in female than male sacra. An anteroposterior view of spine radiograph showed sacral hiatus agenesis in both females (7.81%) and males (4.34%). The anatomical knowledge of sacral hiatus and its variations are important in caudal epidural anesthesia, and it may improve the success rate of caudal epidural anesthesia.

Subchronic hypoxia pretreatment on brain pathophysiology in unilateral common carotid artery occluded albino rats.

OBJECTIVE: This study was aimed to assess the effect of unilateral common carotid artery occlusion on brain pathophysiology in rats pretreated with subchronic hypoxia. MATERIALS AND METHODS: Rats (200 ± 20 g) were randomized into three groups: Group 1 served as sham, Group 2 were normoxic (21% O2 and 79% N2), and Group 3 were hypoxia preconditioned (10% O2 and 90% N2) for 21 days before left common carotid artery occlusion (LCCAO). The LCCAO was done for 75 min followed by reperfusion for 12 h. Neurological scores were recorded. Serum malondialdehyde (MDA) and nitric oxide (NO) levels at pre- and 12 h post-LCCAO were measured. Brain histopathological assessments were also done. RESULTS: Higher neurological deficits scores in Group 2 as compared to Group 3 rats were noticed. Serum MDA and NO levels at 12 h post-LCCAO in Group 2 rats showed significant elevation as compared to preocclusion levels. Group 3 rats did not show such elevations. On histopathology of left and right cerebral hemispheres of Group 1 (sham) did not show any specific changes. In Group 2 rats, the right cerebral hemisphere (nonoccluded) showed no areas of ischemia-induced brain changes, but in the left side (occlusive), there were features of ischemic brain damage including cerebral edema. In the case of Group 3 rats, there were less ischemic damages in the left occluded side as compared to the left side of the Group 2 rats. CONCLUSION: This study clearly demonstrates that subchronic hypoxia pretreatment can reduce ischemic brain injury by unilateral common carotid artery occlusion in rats.

Primary concept of nickel toxicity - an overview.

Toxic metals, including excessive levels of essential metals tend to change biological structures and systems into either reversible or irreversible conformations, leading to the derangement of organ functions or ultimate death. Nickel, a known heavy metal is found at very low levels in the environment. Nickel is available in all soil types and meteorites and also erupts from volcanic emissions. In the environment, nickel is principally bound with oxygen or sulfur and forms oxides or sulfides in earth crust. The vast industrial use of nickel during its production, recycling and disposal has led to widespread environmental pollution. Nickel is discharged into the atmosphere either by nickel mining or by various industrial processes, such as power plants or incinerators, rubber and plastic industries, nickel-cadmium battery industries and electroplating industries. The extensive use of nickel in various industries or its occupational exposure is definitely a matter of serious impact on human health. Heavy metals like nickel can produce free radicals from diatomic molecule through the double step process and generate superoxide anion. Further, these superoxide anions come together with protons and facilitate dismutation to form hydrogen peroxide, which is the most important reason behind the nickel-induced pathophysiological changes in living systems. In this review, we address the acute, subchronic and chronic nickel toxicities in both human and experimental animals. We have also discussed nickel-induced genotoxicity, carcinogenicity, immunotoxicity and toxicity in various other metabolically active tissues. This review specifically highlighted nickel-induced oxidative stress and possible cell signaling mechanisms as well.

Effects of Some Indigenous Plants of North Karnataka (India) on Cardiovascular and Glucose Regulatory Systems in Alloxan-Induced Diabetic Rats.

BACKGROUND: Kenaf (Hibiscus cannabinus Linn, Pundi), Chick pea (Cicer arietinum Linn, Chana) and Prickly lettuce (Lactuca scariola Linn, Hattaraki) leaves are a few of indigenous plants which are routinely consumed by the people of north Karnataka in the diet. Studies on these plants showed some potential anti-diabetic efficacies. OBJECTIVES: To examine the effect of leaves extracts of Hibiscus cannabinus Linn, Cicer arietinum Linn and Lactuca scariola Linn on cardiovascular integrity, glucose homeostasis and oxygen sensing cell signaling mechanisms in alloxan induced diabetic rats. METHOD: In vitro and in vivo tests on glucose regulatory systems and molecular markers such as - NOS3, HIF- 1α and VEGF were conducted in alloxan induced diabetic rats supplemented with all the three plant extracts. Electrophysiological analysis (HRV, LF: HF ratio, baroreflex sensitivity, BRS) and histopathogy of myocardial tissues and elastic artery were evaluated in diabetic rats treated with L. scariola linn. RESULTS: Out of these three plant extracts, Lactuca scariola Linn supplementation showed significant beneficial effects on glucose homeostasis and oxygen sensing cell signaling pathways in alloxaninduced diabetic rats. Furthermore, effects of sub chronic supplementation of Lactuca scariola Linn aqueous extracts showed significant improvement in sympatho-vagal balance in diabetic rats by increase of Heart Rate Variability (HRV) and regaining of Baroreflex Sensitivity (BRS). These results were also corroborated with myocardial and elastic artery histopathology of Lactuca scariola Linn supplemented diabetic rats. CONCLUSION: These findings indicate an adaptive pathway for glucose homeostasis, oxygen sensing cell signaling mechanisms and cardio protective actions in alloxan - induced diabetic rats supplemented with Lactuca scariola Linn extracts.

Sub-chronic indomethacin treatment and its effect on the male reproductive system of albino rats: possible protective role of black tea extract.

BACKGROUND: Indomethacin is commonly used as a nonsteroidal anti-inflammatory drug (NSAID) to treat inflammation, arthritis and joint pains. Unfortunately, it has a wide range of adverse effects on the physiological system, including gonads. This study aimed to assess possible beneficial effects of black tea extract (BTE) against indomethacin-induced alteration of gonadal hormone levels in male rats. METHODS: Adult male rats were divided into Group I (control), Group II (indomethacin, 5 mg/kg body weight [bwt.]; i.p., 21 days), Group III (BTE, 2.5 g tea leaf/dL of water, i.e. 2.5% of aqueous BTE, orally, 21 days) and Group IV (indomethacin+BTE, 21 days). Sperm count and motility, serum luteinising hormone (LH), follicle-stimulating hormone (FSH) and testosterone, along with histopathology of testes were studied. One-way ANOVA, followed by post-hoc t-test were conducted. RESULTS: Indomethacin-treated rats showed significant decrease in testicular weight, sperm count, sperm motility, serum gonadotropins and testosterone concentrations. Histopathology of the testes showed tortuous and distorted seminiferous tubules, marked thickening of the tubular basement membrane, reduced spermatogenesis process (>30%) and marked decrease in the number of interstitial cells of Leydig in indomethacin-treated rats. Interestingly, rats supplemented with BTE showed remarkable improvements in testicular weight gain, sperm count and motility, serum gonadotropins and testosterone concentrations, along with testicular histopathology. CONCLUSIONS: The results suggest that BTE might have potential ameliorative effects against sub-chronic indomethacin-induced alteration of gonadal hormone levels in male albino rats.

A unique branching pattern of the axillary artery: a case report.

During routine dissection classes for under graduate students, we found a unique and unusual case regarding the anomalous branching in the third part of the axillary artery was terminated into subscapular arterial trunk, superficial brachial artery and deep brachial artery. The subscapular arterial trunk was origin of several important arteries as the circumflex scapular, thoracodorsal, posterior circumflex humeral, thoraco-acromial and lateral thoracic arteries. The deep brachial artery in the arm gave anterior circumflex humeral artery at the surgical neck of humerus, which terminated in the cubital fossa by dividing into radial and ulnar arteries. The superficial brachial artery gave two profunda brachii arteries, both of which passed through spiral groove, along with radial nerve and three muscular branches, to brachialis muscle. This variation is very rare. As per our knowledge, we did not find any literature which explained variations which were similar to this. The normal and abnormal anatomy of the axillary region has practical importance among vascular radiologists and surgeons and it should be known for making an accurate diagnostic interpretation.