COVID-19 associated mucormycosis and diabetes mellitus: An exploratory study

Background:Mucormycosis has abruptly increased in Egypt during the third wave of COVID-19 especially in patients with diabetes mellitus (DM). The aim of this study was to investigate the risk factors, clinical presentation and outcome of mucormycosis in COVID-19 patients with diabetes. Methods: Prospective cohort study was conducted on 72 COVID-19 patients with DM presented with mucormycosis at intensive care units and Ear, Nose, and Throat Department of Zagazig University Hospitals over a period of three months from May 2021 to August 2021. All participants were submitted to history taking, examination, laboratory investigation, radiological and histopathology and culture testing. Results: Post COVID-19 new-onset diabetes mellitus (NOD) was detected in 40% of studied patients. 72.2% of patients had poorly controlled diabetes. Majority of studied patients presented by rhino-orbital mucormycosis (90.3%) and about 86% of them were operated. Hundred percent of patients gave history of antibiotic use and also nearly 99.0% of them received corticosteroids, while only 1.4% of them received tocilizumab. There was statistically significant association between operated patients, hemoglobin (HB) level, lymphocyte count, neutrophil-lymphocyte ratio (NLR), and CRP level with disease prognosis. Conclusions: Poorly controlled DM and steroid use are the most important risk for post COVID-19 mucormycosis. Early surgical intervention carried better disease outcome

The diagnostic accuracy of intraoperative frozen section biopsy for diagnosis of sentinel lymph node metastasis in breast cancer patients: a meta-analysis

: Sentinel lymph node (SLN) sampling is important for evaluating the nodal stage of breast cancer when the axillary nodes are clinically free of metastasis. The intraoperative frozen section (IFS) of SLN is used for lymph node assessment. This meta-analysis aims to provide evidence about the diagnostic accuracy and the applicability of IFS of SLN in breast cancer patients. Data were collected by searching PubMed, Cochrane, Scopus, and Web of Science electronic databases for trials matching our eligibility criteria. The statistical analysis included the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and pooled studies' diagnostic odds ratio outcomes. The analyses were conducted using the Open Meta-analyst software. This meta-analysis pooled the results of 110 studies. The overall sensitivity of IFS for SLN metastasis was 74.7%; 95% CI [72.0, 77.2], P < 0.001. It was 31.4% 95% CI [25.2, 38.3], P < 0.001 for the micro-metastasis, and 90.2%; 95% CI [86.5, 93.0], P < 0.001 for the macro-metastasis. The overall specificity was 99.4%; 95% CI [99.2, 99.6], P < 0.001. The overall positive likelihood ratio was 121.4; 95% CI [87.9, 167.6], P < 0.001, and the overall negative likelihood ratio was 0.226; 95% CI [0.186, 0.274], P < 0.001. The overall diagnostic odds ratio of IFS for diagnosing SLN metastasis was 569.5; 95% CI [404.2, 802.4], P < 0.001. The intraoperative frozen section of SLN has good sensitivity for diagnosing breast cancer macro-metastasis. However, the sensitivity is low for micro-metastasis. The specificity is very satisfactory

Derivatization and biological activity studies of 3-chloro-3-chlorosulfenyl spiro tetrahydropyran/tetrahydrothiopyran-4,2'-chroman-4'-one

The adducts 4a,b-7a,b have been obtained either by reducing α-chloro-β-oxosulfenyl chlorides 2a,b with iodide ion in the presence of dienes namely, 2-methyl-1,3-butadiene (isoperene), 2,3-dimethyl-1,3-butadiene, 1,2,3,4-tetrachlorocyclopentadiene, or 1,3-cyclohexadiene, respectively; or by thermolysis of oxadithiin derivatives 3a,b in the presence of the same aforementioned dienes presumably via the formation of the same intermediate A in both cases of compounds 2a,b and 3a,b. It is observed that α-chloro-β-oxosulfenyl chlorides 2a,b undergo straight forward substitution with potassium cyanide to give 8a,b. Direct oxidation of 2a,b with H2O2/AcOH affords 3,3-dichloropyran-4-ones 9a,b, while conversion of 2a,b to the sulfonamides 10a,b followed by oxidation provides 3-chloropyranones 11a,b. Antioxidant and antimicrobial evaluation of compounds 4a,b-6a,b shows moderate activiy. MIC of the derivative 6b reveals a remarkable inhibition of the pathogenic gram positive bacteria (Staphylococcus aureus ) as well as gram negative E coli.

Derivatization and biological activity studies of 3-chloro-3-chlorosulfenyl spiro tetrahydropyran/tetrahydrothiopyran-4,2'-chroman-4'-one

1502-1510The adducts 4a,b-7a,b have been obtained either by reducing α-chloro-β-oxosulfenyl chlorides 2a,b with iodide ion in the presence of dienes namely, 2-methyl-1,3-butadiene (isoperene), 2,3-dimethyl-1,3-butadiene, 1,2,3,4- tetrachlorocyclopentadiene, or 1,3-cyclohexadiene, respectively; or by thermolysis of oxadithiin derivatives 3a,b in the presence of the same aforementioned dienes presumably via the formation of the same intermediate A in both cases of compounds 2a,b and 3a,b. It is observed that α-chloro-β-oxosulfenyl chlorides 2a,b undergo straight forward substitution with potassium cyanide to give 8a,b. Direct oxidation of 2a,b with H2O2/AcOH affords 3,3-dichloropyran-4-ones 9a,b, while conversion of 2a,b to the sulfonamides 10a,b followed by oxidation provides 3-chloropyranones 11a,b. Antioxidant and antimicrobial evaluation of compounds 4a,b-6a,b shows moderate activiy. MIC of the derivative 6b reveals a remarkable inhibition of the pathogenic gram positive bacteria (Staphylococcus aureus ) as well as gram negative E coli

Laparoscopy and intersex : report of 5 cases of male pseudohermaphroditism

From May, 1999 to August, 2006, we performed laparoscopic diagnosis and treatment for 103 cases of impalpable testes. Among those we found 5 cases of male pseudohermaphroditism of different etiologies. Three males presented by impalpable testes with ambiguous genitalia and 2 females presented by primary amenorrhea. All of them have 46-XY normal male chromosomal pattern. In the first 3 cases, the etiology was complete gonadal dysgenesis, and 2 cases with persistent Mullerian syndrome. Timed gonadectomy for the first case and laparoscopic orchiopexy for the other 2 cases were performed. For the other 2 female cases, the etiology was complete androgen insensitivity syndrome and laparoscopic bilateral orchiectomy was performed for both of them. All the procedures were done without complications with satisfactory results

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Infected pancreatic necrosis: outcomes and clinical predictors of mortality. A post hoc analysis of the MANCTRA-1 international study

: The identification of high-risk patients in the early stages of infected pancreatic necrosis (IPN) is critical, because it could help the clinicians to adopt more effective management strategies. We conducted a post hoc analysis of the MANCTRA-1 international study to assess the association between clinical risk factors and mortality among adult patients with IPN. Univariable and multivariable logistic regression models were used to identify prognostic factors of mortality. We identified 247 consecutive patients with IPN hospitalised between January 2019 and December 2020. History of uncontrolled arterial hypertension (p = 0.032; 95% CI 1.135-15.882; aOR 4.245), qSOFA (p = 0.005; 95% CI 1.359-5.879; aOR 2.828), renal failure (p = 0.022; 95% CI 1.138-5.442; aOR 2.489), and haemodynamic failure (p = 0.018; 95% CI 1.184-5.978; aOR 2.661), were identified as independent predictors of mortality in IPN patients. Cholangitis (p = 0.003; 95% CI 1.598-9.930; aOR 3.983), abdominal compartment syndrome (p = 0.032; 95% CI 1.090-6.967; aOR 2.735), and gastrointestinal/intra-abdominal bleeding (p = 0.009; 95% CI 1.286-5.712; aOR 2.710) were independently associated with the risk of mortality. Upfront open surgical necrosectomy was strongly associated with the risk of mortality (p &lt; 0.001; 95% CI 1.912-7.442; aOR 3.772), whereas endoscopic drainage of pancreatic necrosis (p = 0.018; 95% CI 0.138-0.834; aOR 0.339) and enteral nutrition (p = 0.003; 95% CI 0.143-0.716; aOR 0.320) were found as protective factors. Organ failure, acute cholangitis, and upfront open surgical necrosectomy were the most significant predictors of mortality. Our study confirmed that, even in a subgroup of particularly ill patients such as those with IPN, upfront open surgery should be avoided as much as possible. Study protocol registered in ClinicalTrials.Gov (I.D. Number NCT04747990)

Streptococcus dysgalactiae: An emerging pathogen of fishes and mammals

Streptococcus dysgalactiae subsp. dysgalactiae (GCSD) has gained special interest of aquatic health experts throughout the past few years due to its interesting veterinary and public health importance. Increasing records of GCSD infections in farmed fishes have been documented through diverse worldwide aquatic habitats in Japan, China, Malaysia, Indonesia, Taiwan and Brazil. Despite the intraspecies/interspecies dynamic spread of fish GCSD, yet, the genetic basis of its virulence remains unknown. This gap in knowledge is the main reason behind inability to develop a competent vaccine to control the disease in aquatic animals. However, the authors have concluded that the virulence of GCSD is mainly based on its cell surface properties such as high hemagglutination and hydrophobic properties which determine the main adhesive/invasive pathogenic mechanism of the pathogen where GCSD isolates were able to adhere to and invade fish epithelial cell line in vitro. Most recently, the molecular pathogenesis investigations have revealed that, serum opacity factor [SOF], superantigen and streptolysin S genes might be the most important virulence factors that have contributed to the swift propagation of streptococcal infection among aquatic and mammalian species. In conclusion, the current research based review has emphasized the current knowledge gap in epidemiology and control of fish GCSD. To bridge this current gap, a swift future development of high tech/accurate molecular research is highly needed to better understand the pathogenic mechanisms of GCSD

Detection of Saprolegnia parasitica in eggs of angelfish Pterophyllum scalare (Cuvier–Valenciennes) with a history of decreased hatchability

Mass mortalities of angelfish eggs accompanied with very low hatchability were reported in a private ornamental fish farm in Egypt. Examined eggs were badly damaged by water mould that was decisively confirmed as Saprolegnia species. Presumptive identification of the ten retrieved isolates was initially suggestive of Saprolegnia species. Mycological investigations have revealed that only 7 out of 10 isolates were capable of producing sexual stages. Therefore, using molecular tools such as PCR coupled with partial sequencing of inter-transcribed spacer (ITS) gene was one of the most important approaches to distinguish Saprolegnia parasitica from other water moulds. The sequences of ITS gene data derived from eight isolates showed 100% similarity with S. parasitica ATCC90312 sequence and the remaining two isolates were different in one nucleotide (99.9%). The phylogenetic analysis of ITS genes grouped the ten isolates with other S. parasitica in one clad. Further, to control such fungal infection, the efficacy of povidone iodine as surface disinfectant for angelfish and their fertilized eggs were tested. By trial, it was obvious that the obtained post-rinsing results were highly suggestive for the efficacy of povidone iodine as an efficient antifungal disinfectant for both fish and eggs