Evaluation of hospital environment for presence of Mucorales during COVID-19-associated mucormycosis outbreak in India - a multi-centre study.

BACKGROUND: An unprecedented rise in the number of COVID-19-associated mucormycosis (CAM) cases has been reported in India. Myriad hypotheses are proposed for the outbreak. We recently reported uncontrolled diabetes and inappropriate steroid therapy as significant risk factors for the outbreak. However, Mucorales contamination of hospital environment was not studied. AIM: To perform a multi-centre study across India to determine possible Mucorales contamination of hospital environment during the outbreak. METHODS: Eleven hospitals from four zones of India representing high to low incidence for mucormycosis cases were included in the study. Samples from a variety of equipment used by the patients and ambient air were collected during May 19th, 2021 through August 25th, 2021. FINDINGS: None of the hospital equipment sampled was contaminated with Mucorales. However, Mucorales were isolated from 11.1% air-conditioning vents and 1.7% of patients' used masks. Other fungi were isolated from 18% of hospital equipment and surfaces, and 8.1% of used masks. Mucorales grew from 21.7% indoor and 53.8% outdoor air samples. Spore counts of Mucorales in air were significantly higher in the hospitals of North and South zones compared to West and East zones (P < 0.0001). Among Mucorales isolated from the environment, Rhizopus spp. were the most frequent genus. CONCLUSION: Contamination of air-conditioning vents and hospital air by Mucorales was found. Presence of Mucorales in these areas demands regular surveillance and improvement of hospital environment, as contamination may contribute to healthcare-associated mucormycosis outbreaks, especially among immunocompromised patients.

Experience with Ikuta's phalangeal compression-distraction-fixation device.

Proper bony reduction and anatomic alignment without rotational deformity are sometimes difficult to achieve during phalangeal bone lengthening procedures. We report our experience with Ikuta's phalangeal compression-distraction-fixation device, which can be used to achieve proper bony reduction and good alignment and without any rotational deformity.

Dome osteotomy for cubitus varus in children.

In 11 children, varus deformity of the elbow after supracondylar or transcondylar fractures was corrected with a dome osteotomy. The indication was usually cosmetic. The patients were followed for 5 years. The correction was satisfactory in all the cases, and there was no serious complication.

Further technical considerations of the sleeve microanastomosis.

In sleeve anastomoses, stenoses at the suture site have been the main concern. Mechanical dilatation is one way to prevent the stenosis, as suggested by Lauritzen. In the present study, 50 vessels (femoral and carotid) and 10 veins were used for sleeve anastomoses and the same numbers of vessels were used for conventional anastomoses (as control) to evaluate the effect of mechanical dilatation using resin corrosion cast (Mercox) because the Mercox cast facilitates three-dimensional stereoscopic views. Gradual dilatations around the suture sites were observed in seven carotid arteries, and three of seven resulted into aneurysm formation due to weakening of the inner vascular wall in the sleeve anastomosis. No dilatation or aneurysm was observed in the femoral arteries. Newly proliferating capillaries formed on the endothelial surfaces of the inner vascular walls around the suture sites after 4 weeks in the sleeve anastomoses. Operative time and endothelial trauma were markedly reduced with sleeve anastomoses. The gradual dilatation and aneurysm formation in the carotid arteries show that sleeve anastomoses should be used carefully for high-pressure arteries in clinical practice if mechanical dilatation is performed.

Micro-arterial anastomosis using only two sutures and an autogenous cuff.

Microvascular anastomosis using only two sutures and an autogenous cuff was carried out in an experimental model of Wistar albino rats. 40 femoral and 40 epigastric arteries were used for this cuff technique and compared with conventional technique in the same number of vessels. The cuff technique is simple, quick, causes less trauma to the vessel wall and gives a good patency rate. Anastomosis of an artery 0.5mm in diameter is very easy with the cuff technique (98% patency) which remains difficult using conventional technique (0% patency). The disadvantage of this technique may be leakage of blood just after releasing the clamps due to restoration of blood flow, but this is easily controlled within few minutes by mild compression.

Microvascular anastomosis using carbon dioxide (CO2) laser: evaluation by SEM after corrosion cast.

In order to compare the carbon dioxide laser-assisted microvascular anastomosis (CO2 LAMA) with conventional microvascular sutured anastomosis (CMSA), 40 microarterial anastomoses were performed in Wistar albino rats. At different time intervals from zero to four weeks after the procedure, the anastomoses were examined under the scanning electron microscope (SEM) after resin corrosion cast (Mercox). CO2 LAMA was easier and less time-consuming than CMSA, with the same patency rate. Healing of the lumen surface was similar in both procedures, suggesting that CO2 LAMA can be reliably used in microvascular anastomosis.

Arthroplasty of the elbow. Twenty years' experience of a new approach.

We report the use of a new approach for elbow arthroplasty in 58 cases over a 20-year period. A wide exposure, obtained by elevating the triceps attachment and dividing the radial collateral ligament, allows the excision of diseased tissue, articular irregularities and osteophytes. Normal anatomy is restored and active mobilisation can be started 10 days after operation. Good or fair results, with over 70 degrees of joint movement, were achieved in 88% of cases.

Resin corrosion cast in experimental evaluation of femoral microanastomosis.

In order to obtain more information about the site of microvascular anastomosis, the authors used the methylmethacrylate resin corrosion casts. 80 microvascular anastomoses were performed in Wistar albino rats and divided into two groups: in the Group 1 (40 anastomoses), the resin was injected into the vessel whereas in Group 2, the tissues were prepared without injecting resin. Both groups were compared under the scanning electron microscope (SEM). The SEM preparation was easier in the Group 1 and the artefacts were significantly reduced. The anastomotic site was better appreciated in Group 1 in three-dimensional views. The resin corrosion cast is a promising technique for the evaluation of the microvascular anastomosis.

Resin corrosion cast (Mercox) in experimental evaluation of small vessel anastomosis.

This study focuses on obtaining more information about the site of anastomosis, with three-dimensional examination using methylmethacrylate resin (Mercox) corrosion casts. Seventy microvascular anastomoses were performed in Wistar albino rats, divided into two groups before sacrifice. In Group 1 (35), Mercox was injected into the vessels, whereas in Group 2 (35), the tissues were prepared without injecting Mercox. Both groups were compared under the scanning electron microscope (SEM). The SEM preparation in Group 1 was simple, easy, and artifacts were significantly minimized. The anastomotic site could be well appreciated in three-dimensional views. Clear negative imprints of the endothelial surface were achieved without any breakage in the Mercox corrosion cast, and it can be reliably used in the evaluation of small vessel anastomosis.