Rhino-ocular and rhino-oculo-cerebral mucormycosis; two extremes of clinical spectrum complicating COVID-19 disease: two case reports

Corona virus disease 2019 is associated with wide spectrum of clinical features and secondary events complicating the natural course of disease, including infectious and noninfectious complications. As pandemic is evolving wide range of secondary infections including bacterial and fungal infections complicating the clinical course of COVID-19 disease are being reported, authors report two cases of rhino-orbital and rhino-orbito-cerebral mucormycosis in a patient of COVID-19 pneumonia. Mucormycosis is caused by saprophytic fungi involving nasal passages, sinuses, oral cavity and brain commonly. It is usually seen immunocompromised host and in diabetics with poorly controlled blood sugar level at times normal host though rare. High index of clinical suspicion is needed to suspect and diagnose mucormycosis to maximize the survival as disease is highly fatal because of its angio-invasive pathology

A case report of pulmonary and muscular cysticercosis

Pulmonary cysticercosis is extremely rare manifestation of a rather common disease which is distributed worldwide. Most common sites for the growth of cysticercosis are muscle and brain followed by eye. Pulmonary involvement in cysticercosis is very rare and if at all present, then ill-defined nodular shadows distributed throughout the lung is the usual radiological presentation which might be attributed to other diseases also. No case of cysticercosis presenting as lung parenchymal along with muscular involvement without cerebral involvement has been reported so far in literature. We came across a rarest presentation of cysticercosis as pulmonary involvement. After nullifying all the differential diagnosis of parenchymal nodular lesions as seen on CT chest and with clinical suspicion, a diagnosis of pulmonary cysticercosis was made as enzyme linked immunosorbent assay (ELISA) titres for cysticercosis was significantly raised. Case was successfully treated with albendazole (15 mg/kg) with steroid cover with resolution of lesions as well.

Levetiracetam monotherapy effect on serum calcium and serum vitamin D in patient of epilepsy

Background: Objective of the study was to determine the Levetiracetam monotherapy effect on serum calcium and serum vitamin D levels in tertiary care hospital in Haryana, India.Methods: A total of 110 patients with epilepsy, were enrolled to the study for one year between April 2013 to August 2014. All male patients aged 15-60 years and premenopausal females with epilepsy were included in the study. The study was a interventional prospective study design. The antiepileptic drug levetiracetam was administered starting from a dose of 20 mg/kg and dose was titrated according to the clinical response. During the follow up period, the subjects were asked about the seizure frequency and other side effects. The patients were be subjected to questionnaires based proforma. Baseline investigations, Hemogram, renal and liver function tests, calcium, phosphate, vitamin D and bone mineral density and T scores were noted. All investigations were repeated after one year of levetiracetam monotherapy.Results: The mean age of onset of seizures in the study group was 23.22±6.62 years. 58% (n=29) were seizure free after 1 year of levetiracetam monotherapy, 28% patients had adequate control and 14% patients had poor control of their seizure episodes. There was an insignificant change in Hemoglobin, total leukocyte count, platelet count, renal parameters and Liver enzymes from baseline over a year of levetiracetam therapy. Serum calcium levels increased insignificantly from baseline levels of 9.68±0.59 mg/dl to 9.72±0.56mg/dl. Vitamin D levels increased from baseline of 39.35±14.91ng/ml to 39.84±14.07 ng/ml. Bone mineral density increased insignificantly from baseline of 0.92±0.13 g/cm2 to 0.93±0.13 g/cm2.Conclusions: Present study has shown an overall beneficial effect on serum calcium, Vitamin D level, bone mineral density and T scores on DEXA scan

COVID-19 pneumonia and mucormycosis a new challenging duo- rhino-occulo-cerebral mucormycosis: a case report

The pandemic of corona virus disease 2019 (COVID-19) has posed challenge not only in management of the primary disease but the emerging complications associated with COVID-19 has further complicated the course of disease. The course of COVID-19 disease is associated with infectious and noninfectious complications former include secondary bacterial and fungal infection adding to mortality and morbidity. COVID-19 disease associated candidiasis and aspergillosis have been reported as super infections but with the steroid and supplemental oxygen as mainstay treatment modality mucormycosis is now complicating the course of disease and presently posing challenge in India with already overburdened health care service. Mucorales is a saphrophytic fungi causes rhinocerebral infection involving nasal passages, sinuses, oral cavity and brain. It is usually seen in immunocompromised host and in diabetics with poorly controlled blood sugar level. High degree of clinical suspicion is needed to suspect and diagnose mucormycosis. It is a fatal disease because of its angioinvasive pathogenesis and treatment is promptly initiated to salvage mortality and morbidity. Authors report a case of rhino-oculo-cerebral mucormycosis in a middle-aged diabetic patient with severe COVID-19 disease

Dietary supplementation of black soldier fly (Hermetica illucens) meal modulates gut microbiota, innate immune response and health status of marron (Cherax cainii, Austin 2002) fed poultry-by-product and fishmeal based diets

The present study aimed to evaluate the dietary supplementary effects of black soldier fly (Hermetia illucens) (BSF) meal on the bacterial communities in the distal gut, immune response and growth of freshwater crayfish, marron (Cherax cainii) fed poultry-by-product meal (PBM) as an alternative protein source to fish meal (FM). A total of 64 marron were randomly distributed into 16 different tanks with a density of four marron per tank. After acclimation, a 60-days feeding trial was conducted on marron fed isonitrogenouts and isocalorific diets containing protein source from FM, PBM, and a combination of FM + BSF and PBM + BSF. At the end of the trial, weight gain and growth of marron were found independent of any dietary treatment, however, the two diets supplemented with BSF significantly (P < 0.05) enhanced haemolymph osmolality, lysozyme activity, total haemocyte counts, and protein and energy contents in the tail muscle. In addition, the analysis of microbiota and its predicted metabolic pathways via 16s rRNA revealed a significantly (P < 0.05) higher bacterial activity and gene function correlated to biosynthesis of protein, energy and secondary metabolites in PBM + BSF than other dietary groups. Diets FM + BSF and PBM + BSF were seen to be associated with an up-regulation of cytokine genes in the intestinal tissue of marron. Overall, PBM + BSF diet proved to be a superior diet in terms of improved health status, gut microbiota and up-regulated expression of cytokine genes for marron culture

Silicosis with bilateral spontaneous pneumothorax

Presentation with simultaneous bilateral pneumothorax is uncommon and usually in the context of secondary spontaneous pneumothorax.The association of pneumothorax and silicosis is infrequent and most cases are unilateral. Bilateral pneumothorax in silicosis is very rare with just a few reports in medical literature

Study of lipid profile in young patients (age 40 years or below) with acute coronary syndrome

Background: Acute coronary syndrome (ACS) refers to a group of clinical symptoms compatible with acute myocardial ischemia and includes unstable angina, non-ST segment elevation myocardial infarction and ST-segment elevation myocardial infarction. Aims and Objectives: To study the incidence of lipid profile abnormalities in young patients (age 40 years or below) with ACS with clinical and cardiovascular risk profile. Material and Methods: The study was conducted on 223 young patients of acute coronary syndrome with age 40 years or below. 89 young patients with acute coronary syndrome having lipid abnormalities were further followed up after 1 month. Results: Majority of patients (55.15%) in the study population belonged to 35–40 years age group. Mean age of study population was 35.65 + 4.62 years with 90.13% males and 9.86% females. Main presenting symptom was precordial chest pain in 93.72% patients. Smoking was the commonest risk factor in young adults (81.7%). Other risk factors like diabetes, hypertension, family history were less common in young adults. Drug addiction was also higher in younger population (16%). Majority of young adults with acute coronary syndrome had more than 1 (47.53%) risk factor. Majority of patients were in Killip class I (86.9%) and only few patients (13.1%) had Killip class II or above. ST elevation myocardial infarction was far more common than NTEMI/USA and was found in 164 (73.5%) patients. Most common type of infarction was anterior wall myocardial infarction (62.80%). Majority of young patients had negative TMT, so it suggests that ACS in younger population has lesser complications during presentation, hospital stay and on follow-up. Conclusion: ACS in young continues to increase in Indian subcontinent. Younger patient with an ACS have different clinical characteristics and a different prognosis than older patients. The extent of CAD and degree of myocardial necrosis has influence on presentation and subsequent MACE in ACS and in this study, it appears dyslipidemia do not play any significant role in influencing extent of CAD and has little effect on outcome whether during acute stage or on immediate follow-up after ACS

TUBERCULOSIS OF SPLEEN PRESENTING WITH PYREXIA OF UNKNOWN ORIGIN IN A NON-IMMUNOCOMPROMISED WOMAN

Splenic lesions due to tuberculosis are extremely rare in immunocompetent indi-viduals and delays in diagnosis are frequent. Here, we describe a 49-year-woman presenting with pyrexia-of-unknown origin with no evidence of any immunodefi-ciency. Computed tomography of the abdomen showed an enlarged spleen having multiple small focal hypodense lesions; the later were confirmed to be of tubercu-lous etiology on histopathological examination. She had favorable response with anti-tubercular chemotherapy. We report this case of tuberculosis spleen in an im-munocompetent individual for its rarity and to highlight the fact that these patients can be managed by medical treatment effectively

Pneumothorax: A rare presentation of pulmonary mycetoma

Pneumothorax due to mycetoma is extremely rare and has been described only in patients undergoing intensive cytotoxic therapy for hematologic malignancies. A non-immunocompromised subject presenting with pneumothorax due to rupture of the mycetoma into the pleural cavity is being described here

Silicosis with bilateral spontaneous pneumothorax

Presentation with simultaneous bilateral pneumothorax is uncommon and usually in the context of secondary spontaneous pneumothorax. The association of pneumothorax and silicosis is infrequent and most cases are unilateral. Bilateral pneumothorax in silicosis is very rare with just a few reports in medical literature