Comparative Study of Clinical Severity and Biochemical Markers in Pre COVID-19 and COVID-19 Rhino-Orbito Cerebral Mucormycosis.

In view of high surge of sinonasal mucormycosis cases after the second wave of covid 19, present study was planned to know and compare the clinical severity of the disease and also to better understand the difference in the biochemical markers during precovid and post covid period. This retrospective observational study included all cases of sinonasal mucormycosis which were treated in our institute from August 2012 to August 2021. Details of these cases were collected from hospital database system. Biochemical parameters included FBS, HbA1C, urine ketone bodies, blood pH and creatinine. Clinical severity score was measured using self-structured severity scoring system. We found that out of 74 cases treated in our hospital 28 cases were in pre covid period while 46 cases belonged to covid 19 period. Higher male predominance was seen during post covid period (76% vs. 60%). Urine ketone bodies were positive in 7% patients in precovid period compared to 26% in post-covid period. FBS and HbA1C were high approximately 80 and 90% patients respectively in both groups. Clinical severity was significantly high in post covid patients. The present study showed that in spite of similar biochemical profile. The severity of mucormycosis was high in covid positive patients. This study shows that Covid-19 is an independent high risk factor in mucormycosis patients.

Mucoceles of Paranasal Sinuses: A Single Centre Experience.

Describe experience of managing paranasal sinus mucoceles, with either endoscopic endonasal approach (EESS) or combined external with EESS approach. Retrospective study done at SDMCMS&H, between 2007 and 2019, on patients undergoing surgical excision of mucocele. Results described as mean, median, mode, percentages. Twenty-one patients were included, with male to female ratio (0.75:1), mean age (42.95 years). Commonest presentation were facial pain (42.85%),visual symptoms (28.57%), headache (23.80%). Signs included, proptosis (52.38%), facial deformity (23.80%). Imaging: showed frontal mucoceles (42.85%), fronto-ethmoid (38.09%), ethmoid (14.28%), sphenoid (4.76%). Orbital extension in 42.85%, sinusitis (33.33%), skull base erosion (23.80%). EESS or combined external and EESS approach (61.90%, 38.09% respectively) were performed. Complete excision of mucocele wall done. Recurrence in two cases(average-2.5 years),revision surgery performed without further recurrences. Either EESS or combined external and EESS approach used based on site and extension of mucoceles. Complete peeling of mucocele wall without obliteration of the sinus cavity was the mode of surgical management in all cases.

Mycobacterium tuberculosis strain lineage in mixed tribal population across India and Andaman Nicobar Island.

In India, the tribal population constitutes almost 8.6% of the nation's total population. Despite their large presence, there are only a few reports available on Mycobacterium tuberculosis (M. tb) strain prevalence in Indian tribal communities considering the mobile nature of this population and also the influence of the mainstream populations they coexist within many areas for their livelihood. This study attempts to provide critical information pertaining to the TB strain diversity, its public health implications, and distribution among the tribal population in eleven Indian states and Andaman & Nicobar (A&N) Island. The study employed a population-based molecular approach. Clinical isolates were received from 66 villages (10 states and Island) and these villages were selected by implying situation analysis. A total of 78 M. tb clinical isolates were received from 10 different states and A&N Island. Among these, 16 different strains were observed by spoligotyping technique. The major M. tb strains spoligotype belong to the Beijing, CAS1_DELHI, and EAI5 family of M. tb strains followed by EAI1_SOM, EAI6_BGD1, LAM3, LAM6, LAM9, T1, T2, U strains. Drug-susceptibility testing (DST) results showed almost 15.4% of clinical isolates found to be resistant to isoniazid (INH) or rifampicin (RMP) + INH. Predominant multidrug-resistant (MDR-TB) isolates seem to be Beijing strain. Beijing, CAS1_DELHI, EAI3_IND, and EAI5 were the principal strains infecting mixed tribal populations across India. Despite the small sample size, this study has demonstrated higher diversity among the TB strains with significant MDR-TB findings. Prevalence of Beijing MDR-TB strains in Central, Southern, Eastern India and A&N Island indicates the transmission of the TB strains.

Perioperative only versus extended antimicrobial usage in tympanomastoid surgery: a randomized trial.

OBJECTIVES/HYPOTHESIS: Antimicrobial prophylaxis is still a matter of debate in ear surgeries. Previous studies have focused on prophylaxis in middle ear surgery alone without inclusion of mastoidectomy. We therefore investigated efficacy of two regimes of antimicrobial prophylaxis in tympanoplasty with cortical mastoidectomy done for mild middle ear disease in chronic otitis media. STUDY DESIGN: Prospective, randomized, controlled, double-blind study. METHODS: Patients undergoing tympanoplasty with cortical mastoidectomy were included and randomized into two study groups. The group I patients received parenteral perioperative antimicrobials; only group II patients received additional extended oral antimicrobials for 8 days more postoperatively. Primary outcomes evaluated were postaural wound infection and graft success, assessed weekly until 1 month. Adverse events and length of hospital stay were evaluated as secondary outcome. RESULTS: Seventy-eight patients were randomized into group I (n = 39) and group II (n = 39). The two groups showed no difference in wound infection rate. The graft success rate in both the group was comparable (94.87% in group I and 97.44% in group II, respectively; P = 1.00). The length of hospital stay was significantly longer (P = 0.00001) in group II (3.05 [0.72], mean [SD]) as compared to group I (2.36 [0.49]). During the first postoperative week, a significantly higher incidence of gastrointestinal disturbances were observed in group II (19 [48.72%] as compared to 1 [2.56%] in group I, P = 0.00001). CONCLUSION: The present study shows that there is no need of extended antimicrobial prophylaxis for tympanoplasty with cortical mastoidectomy done for mild middle ear disease. An indiscriminate use of antimicrobials may lead to increase incidence of adverse events and prolonged hospital stay. LEVEL OF EVIDENCE: 1b.

Unmasking of tracheomalacia following short-term mechanical ventilation in a patient of adult respiratory distress syndrome.

Patients with chronic obstructive pulmonary disease (COPD) are susceptible to airway malacia, which may be unmasked following mechanical ventilation or tracheostomy decannulation. Dynamic imaging of central airways, a non-invasive test as effective as bronchoscopy to diagnose airway malacia, has increased the recognition of this disorder. We describe a 70-year-old woman admitted with adult respiratory distress syndrome. She had cardiorespiratory arrest on admission, from which she was successfully resuscitated. She had obesity, hypertension, diabetes mellitus, recurrent ventricular tachycardia, sarcoidosis with interstitial lung disease and COPD. She received short-term (18 days) mechanical ventilation with tracheostomy and developed respiratory distress following tracheostomy decannulation.

Medical attribution of common mental disorders in a rural Indian population.

Common mental disorders (CMD) refer to anxiety and depressive disorders causing significant disability and are commonly encountered in communities. Early diagnosis and treatment of these disorders can be improved if the population has a better understanding of them. This study aimed to explore the medical attribution of CMD among a rural community in South India using case vignettes. While most respondents agreed that there was a problem, they showed a preference for lay help over medical treatment. Improving awareness among rural communities of the usefulness of medical help for CMD might facilitate early diagnosis and treatment for these disorders.

Emerging antibiotic resistance in bacteria with special reference to India.

The antibiotic era started in the 1940s and changed the profile of infectious diseases and human demography. The burgeoning classes and numbers promised much and elimination of this major cause of human (and animal) morbidity appeared possible. Bacterial antibiotic resistance which was observed soon after antibiotic introduction has been studied extensively. Diverse mechanisms have been demonstrated and the genetic basis elucidated. The resilience of the prokaryote ecosystems to antibiotic stress has been realized. The paper presents these subjects briefly to afford an overview. The epidemiology of antibiotic resistance is dealt with and community practices in different countries are described. The role of high antibiotic usage environments is indicated. The implication of the wide use of antibiotics in animals has been pointed out. Steadily increasing antibiotic resistance and decreasing numbers of newer antibiotics appear to point to a post-antibiotic period during which treatment of infections would become increasingly difficult. This article attempts to review the global antimicrobial resistance scene and juxtaposes it to the Indian experience. The prevalence in India of antibiotic resistance among major groups of pathogens is described. The factors that determine the prevalent high antibiotic resistance rates have been highlighted. The future research activity to ensure continued utility of antibiotics in the control of infections has been indicated.

PREVALENCE OF ANTIBODIES TO HEPATITIS C VIRUS IN HOSPITALIZED POPULATION SUBSETS.

Prevalence of antibodies to hepatitis C virus (anti-HCV antibody) was ascertained in different subsets of hospitalized patients. Anti-HCV antibody testing was done using a third generation test The anti-HCV positivity in the sera of 308 tuberculosis patients, who had been given streptomycin, was 12.3 per cent It was 7.1 percent among 84 cardiac patients undergoing invasive cardiac procedures, 15.6 per cent in 77 patients on haemodialysis and 41.2 per cent patients with surgical jaundice. It is surmised that hospitalization, particularly parenteral therapy and invasive procedures during hospitalization, puts patients at higher risk of contracting HCV infecticn.

CAN WE SATISFY OUR CLIENTS? INTROSPECTION.

Criticism of medical professionals is on the rise. The perception of the medical profession and the media, which educates the clientele, is widely different. The likely causes for dissatisfaction of the clientele and some possible solutions are presented.

ENTERIC FEVER - CULTURE AND SENSITIVITY PATTERN AND TREATMENT OUTCOME.

One hundred cases of enteric fever in the age group of 6 months to 12 years were analysed with respect to culture sensitivity pattern and treatment outcome. Patients were divided into 5 treatment groups - chloramphenicol, amoxycillin, trimethoprim-sulfamethoxazole + furazolidine, gentamicin + cephalexin and ciprofloxacin. Out of 91 culture positive cases, 100% were sensitive to ciprofloxacin followed by gentamicin (84.9%), cephalexin (83.6%), furazolidine (36.6%), trimethoprim-sulfamethoxazole (34.1%), chloramphenicol (34.0%) and amoxycillin (23.8%). In 60 cases resistant to chloramphenicol, resistance to other drugs varied from 20 to 88.3%. The treatment response was 100% to ciprofloxacin, 72.7% to chloramphenicol, 50% to gentamicin + cephalexin, 38.5% to trimethoprim-sulfamethoxazole + furazolidine and 12.5% to amoxycillin. Out of 48 cases who did not respond to initial regimen, 33 were treated successfully with ciprofloxacin and remaining with other drug regimens. Time taken for defervescence was shortest with gentamicin + cephalexin (4.6±2.0 days) followed by ciprofloxacin (6.1±2.5 days) and chloramphenicol (6.4±3.5 days). There were 3 deaths in this study.

Human leucocyte antigen and insulin dependent diabetes mellitus.

HLA typing was done in 25 cases of insulin dependent diabetes mellitus (IDDM) and compared with 60 healthy controls. There was a significantly increased frequency of HLA B-8, HLA B-12 and HLA DR-3 in IDDMO. The odds ratio (relative risk) of developing IDDM for HLA B-8 was 4.42 (p less than 0.10), for HLA B-12 was 3.56 (p less than 0.10) and for HLA DR3 9.75 (p less than 0.001). There was no correlation of HLA specificity with complications of diabetes.