Diagnosis of mucormycosis from nasal swabs using commercial PCR platforms; a feasible alternative?

Rhino-orbital-cerebral mucormycosis (ROCM) is linked to uncontrolled diabetes, diabetic ketoacidosis, iron overload, corticosteroid therapy, and neutropenia. This study evaluated a commercial real-time PCR system's effectiveness in detecting Mucorales from nasal swabs in 50 high-risk patients. Nasal swab PCR showed 30% positivity, compared to 8% with KOH microscopy. Despite its improved sensitivity, nasal swab PCR has limitations, highlighting the importance of established sampling methods in mucormycosis diagnosis. Participants were predominantly male (64%), with diabetes (78%) and amphotericin B use (96%). Prior COVID-19 was 42%, with 30% positive for Mucorales by PCR, compared to 8% with KOH microscopy.

Clinico-mycological characteristics and outcomes of rare yeast infections.

Unusual fungi, encountered infrequently in practice, present a significant diagnostic challenge, leading to potential delays in diagnosis and treatment. This study aims to describe a number of cases, where infections were caused by rare yeast pathogens. Organisms isolated included rare Candida species, Geotrichum, Lodderomyces and Trichosporon species. The mean duration of the outcome of the patients from microbiological diagnosis was 20 days. A total of 3 patients succumbed to their illness. This study aims to shed light on the varied clinical presentation and outcome of infections caused by rare yeast pathogens.

Malarial Antibodies and Endemicity: Does It Affect SARS-CoV-2 Severity and Outcomes?

Background India has a disproportionately lower rate of coronavirus disease 2019 (COVID-19) severe disease and lower death rates with respect to other parts of the world. It has been proposed that malaria-endemic countries such as India are relatively protected against severe COVID-19 disease and deaths. Methods This was a cross-sectional, analytical, observational study conducted from August 2020 to July 2021 at a tertiary care COVID-19-designated center in New Delhi, India. It aimed to study the association between antimalarial antibody levels and COVID-19 disease severity and outcomes. Results One hundred forty-six patients were included in the final analysis. The mean (standard deviation {SD}) age of the study population was 44.6 (17.2) years, and there were 85 (58.2%) males. Sixty-five patients had mild disease, 14 patients had moderate disease, and 67 patients had severe disease at the time of enrolment in the study. Forty-six patients expired during the hospital stay. For the antimalarial antibody, there was a statistically significant difference between mild and moderate (p=0.018), mild and severe (p=0.016), and mild and combined moderate and severe diseases (p=0.013). However, there was no difference between the patients who survived and those who did not. Conclusion Antimalarial antibody levels may not be associated with the outcomes of COVID-19 during hospital stay. However, this study has provided some insights into the relationship between the severity and outcomes of COVID-19 and the levels of antimalarial antibodies.

Utility of Walk Tests in the Progression of Mild COVID-19 Infection at a Tertiary Hospital in North India.

INTRODUCTION: There have been 214 million confirmed cases of COVID-19 worldwide, with a total death tally of 4.4 million. The current study aims to determine the predictive value of various scores in the assessment of progression of mild COVID-19 infection at a tertiary care hospital in North India. METHODS: The study population consisted of adults (age more than 18 years) with a confirmed diagnosis of COVID-19 by RT-PCR on nasopharyngeal specimens. Patients with only mild illness were enrolled. After the patients were admitted to the isolation ward, the presenting history, comorbidity status, vital signs and laboratory parameters were recorded. The 3 and 6 minutes walk test was performed daily from admission till discharge or progression of the severity of COVID- 19, and it was used to calculate Borg Dyspnoea Score (BDS) and National Early Warning Score (NEWS2) scores. RESULTS: Our study consisted of 50 patients with 34 (68%) males, and the mean (SD) age of the patient population was 28.1 (6.4) years. The most common symptoms were fever, sore throat, and cough. All laboratory parameters were within normal ranges for all the patients. 96% recovered without progression, while only 4% of them progressed to moderate illness. Results of the 3 and 6 minutes walk tests, BDS and NEWS2 scores showed improvement over the course of the hospital stay. CONCLUSION: Although the walk tests and the scores improved over time, they failed to predict the disease progression.

SyNC, a Computationally Extensive and Realistic Neural Net to Identify Relative Impacts of Synaptopathy Mechanisms on Glutamatergic Neurons and Their Networks in Autism and Complex Neurological Disorders.

Synaptic function and experience-dependent plasticity across multiple synapses are dependent on the types of neurons interacting as well as the intricate mechanisms that operate at the molecular level of the synapse. To understand the complexity of information processing at synaptic networks will rely in part on effective computational models. Such models should also evaluate disruptions to synaptic function by multiple mechanisms. By co-development of algorithms alongside hardware, real time analysis metrics can be co-prioritized along with biological complexity. The hippocampus is implicated in autism spectrum disorders (ASD) and within this region glutamatergic neurons constitute 90% of the neurons integral to the functioning of neuronal networks. Here we generate a computational model referred to as ASD interrogator (ASDint) and corresponding hardware to enable in silicon analysis of multiple ASD mechanisms affecting glutamatergic neuron synapses. The hardware architecture Synaptic Neuronal Circuit, SyNC, is a novel GPU accelerator or neural net, that extends discovery by acting as a biologically relevant realistic neuron synapse in real time. Co-developed ASDint and SyNC expand spiking neural network models of plasticity to comparative analysis of retrograde messengers. The SyNC model is realized in an ASIC architecture, which enables the ability to compute increasingly complex scenarios without sacrificing area efficiency of the model. Here we apply the ASDint model to analyse neuronal circuitry dysfunctions associated with autism spectral disorder (ASD) synaptopathies and their effects on the synaptic learning parameter and demonstrate SyNC on an ideal ASDint scenario. Our work highlights the value of secondary pathways in regard to evaluating complex ASD synaptopathy mechanisms. By comparing the degree of variation in the synaptic learning parameter to the response obtained from simulations of the ideal scenario we determine the potency and time of the effect of a particular evaluated mechanism. Hence simulations of such scenarios in even a small neuronal network now allows us to identify relative impacts of changed parameters and their effect on synaptic function. Based on this, we can estimate the minimum fraction of a neuron exhibiting a particular dysfunction scenario required to lead to complete failure of a neural network to coordinate pre-synaptic and post-synaptic outputs.

Gargle lavage & saliva: Feasible & cheaper alternatives to nasal & throat swabs for diagnosis of COVID-19.

Background & objectives: In the present scenario, the most common sample for diagnosis of COVID-19 by reverse transcription polymerase chain reaction (RT-PCR) is nasal and throat swab (NTS). Other sampling options such as gargle lavage have found limited application in clinical use mostly because of unavailability of an appropriate gargling liquid. This study was conducted to assess the stability of SARS-CoV-2 RNA in normal saline at 4°C that can serve as a gargling liquid as well as a transport medium. The study also looked at the agreement between NTS and gargle lavage/saliva for the detection of SARS-CoV-2. Methods: In 29 consecutive real-time RT-PCR (rRT-PCR) positive COVID-19 patients, paired NTS, gargle and saliva samples were taken. Samples were processed by rRT-PCR for the detection of SARS-CoV-2 RNA. To assess the SARS-CoV-2 RNA stability in normal saline, gargle lavage specimens were divided into two aliquots; one subset of the specimen was run within 4-6 h along with the routine samples (NTS and saliva) and the other subset was stored at 4°C and processed after 24-30 h. Agreement between cycle threshold (Ct) values from both the runs was compared using Bland-Altman (BA) analysis. Results: The positivity rates of rRT-PCR in NTS, saliva and gargle lavage samples were 82.7 (24/29), 79.3 (23/29) and 86.2 per cent (25/29), respectively. BA plot showed a good agreement between the Ct values of fresh and stored gargle samples, stipulating that there were no significant differences in the approximate viral load levels between the fresh and stored gargle lavage samples (bias: E gene -0.64, N gene -0.51, ORF gene -0.19). Interpretation & conclusions: Our study results show stability of SARS-CoV-2 RNA in the gargle samples collected using normal saline up to 24-30 h. Gargle lavage and saliva specimen collection are cost-effective and acceptable methods of sampling for the detection of SARS-CoV-2 RNA by rRT-PCR. These simplified, inexpensive and acceptable methods of specimen collection would reduce the cost and workload on healthcare workers for sample collection.

Assessment of Preventive Practices Followed by General Public During COVID-19 Pandemic - A Cross-Sectional Survey From India.

Objectives COVID-19 has infected millions of people across the globe, leading to hundreds of thousands of deaths. Currently, there are no vaccines available for COVID-19, and the most effective way to curb its spread is to follow preventive practices. The present study aimed to assess the extent of adoption of preventive practices among the general population in India. Methods A web-based cross-sectional survey was carried out recruiting 964 participants from all over India through purposive sampling. A pre-validated questionnaire consisting of 37 questions was used to collect data. Items 1A to 18A covered various preventive practices and items 1B to 19B covered reasons for not following those preventive practices. Descriptive statistics, chi-square tests, t-tests and one-way analysis of variance (ANOVA) were conducted. Results Most participants reported taking precautions such as wearing masks (91.80%), covering both nose and mouth (79.14%) and avoiding hand shaking (83.40%). However, practices like following social distancing in public places (51.76%) and workplace (51.04%), frequent hand washing/sanitising (63.59%) and washing hands for at least 20 seconds (45.44%) were less commonly observed. Participants failed to follow social distancing because of overcrowding and lack of space. They also found it cumbersome to wash hands multiple times. Female participants and people residing in metropolitan and small cities were fairly doing well in following preventive practices. Conclusion The study helped in identifying the glitches in following various preventive practices against COVID-19 during unlock phase and reasons for the failure to perform these practices.

Is excess weight a risk factor for the development of COVID 19 infection? A preliminary report from India.

BACKGROUND AND AIM: This study explored the association between BMI and COVID-19 positive status in a tertiary care hospital from New Delhi. METHODS: Three hundred and seventy nine adult patients who presented to COVID-19 screening outpatient department of the hospital were interviewed over the phone regarding their body weight and height. The COVID-19 RT-PCR report of the patients was extracted from the hospital information system. RESULTS: The mean BMI and the prevalence of obesity was observed to be higher in individuals who were detected to be COVID-19 RT-PCR positive as compared to those who were negative. With every one-unit increment in BMI above 23 kg/m2, the odds of being COVID-19 positive increased by 1.8 times among these patients. CONCLUSION: The findings suggest a dose-response association between BMI and the odds of COVID-19 infection in individuals with excess weight.

Association Between Self-Reported Adherence to Preventive Practices and Probability of Turning COVID-19 Positive: A Cross-Sectional Analytical Study.

Background Preventive practices are the mainstay to mitigate the spread of the COVID-19 pandemic. We tried to assess the self-reported adherence of our participants to the already known preventive practices. Furthermore, we tried to determine whether the non-compliance to specific preventive practices was associated with the acquisition of the infection or not. Methods We enrolled 379 healthcare workers, hospital staff, and their family members who were tested for COVID-19 by reverse transcription-polymerase chain reaction (RT-PCR) in an outpatient clinic. Socio-demography and the infection prevention practices of the individuals were recorded in a preformed questionnaire. Statistical analysis was performed to find out the statistical association between these factors and the RT-PCR results. Adjusted and unadjusted odds ratios were determined to find out the degree of protection provided by each of the preventive practices concerning the development of the disease. Results Social distancing (p<0.001), hand hygiene (p<0.001), ensuring N-95 mask fit check (p<0.001), and the use of alternative medications (p=0.002) were found to be protective. Resident doctors were at a lower risk of developing the disease as compared to the other healthcare workers (odds ratio: 0.39). Conclusion The failure to practice the already known preventive practices is probably one of the most important factors in the progression of the COVID-19 pandemic. Adherence to these practices is the intervention of choice to reduce disease transmission in the current scenario.