Mucormycosis: a rare but rising fungal infection in COVID-19 patients at tertiary care centre

Background: New pandemic Coronavirus disease 2019 (COVID-19) shows wide range of disease pattern from mild to life threatening pneumonia in association with bacterial and fungal infections. Invasive fungal infections are becoming new burden in COVID-19 patients especially when associated with diabetes mellitus.Methods: We have studied 90 patients of invasive fungal sinusitis at tertiary care centre over a period of 3 months from March 2021 to June 2021 prospectively. All patients suspected for invasive fungal sinusitis in association with covid19 are included. Results: 67 males and 23 females of age group 41 to 70 years were presented as case of invasive fungal sinusitis with suspicion of Mucormycosis. Disease extended to orbit in 90 patients, to hard palate in 33 and skin involved in 5 patients. Diagnosis based on clinical presentation, computed tomography (CT scan) findings, KOH preparation and culture. KOH showing fungal elements in 62 patients and fungi isolated in 37 patients. Aspergillus group and mucorales contribute equally being found in 17 samples each. 23 patients lost their life due to this disease. This study is done and reported first time from this tertiary care centre.Conclusions: Invasive fugal sinusitis including Mucormycosis otherwise rare disease has significantly increased in COVID-19 pandemic. Immune dysregulation due to COVID-19, Diabetis mellitus and wide spread use of corticosteroids/antibiotics all contributed to this rise in cases of invasive fungal diseases. Early diagnosis, surgical intervention and antifungal treatment help to reduce mortality and morbidity

FAST DISPERSING TABLETS REVIEW

ABSTRACT In this investigation fast dissolving tablets were prepared using different Superdisintegrants like crospovidone, croscarmellose sodium and sodium starch glycolate by direct compression method. FDTs were evaluated for physicochemical properties like thickness, uniformity of weight, content uniformity ,hadness, friability, wetting time ,dispersion time in vitro disintegration time and in vitro dissolution. Wetting time of formulations containing Croscarmellose sodium was least and tablets showed fastest disintegration. The drug release from FDTs increased with increasing concentration of superdisintegrants and was found to be highest with formulations containing Croscarmellose sodium. The tablet disintegrated within 16 to 45 seconds. Almost 96% of drug was released from the forumaltion within 16 min. The release of drug from FDTs was found to follow non-Fickian diffusion kinetics.Stability studies of the tablets shows non significant change

Lifetime of 19Ne*(4.03 MeV)

The Doppler-shift attenuation method was applied to measure the lifetime of the 4.03 MeV state in 19Ne. Utilizing a 3He-implanted Au foil as a target, the state was populated using the 20Ne(3He,alpha)19Ne reaction in inverse kinematics at a 20Ne beam energy of 34 MeV. De-excitation gamma rays were detected in coincidence with alpha particles. At the 1 sigma level, the lifetime was determined to be 11 +4, -3 fs and at the 95.45% confidence level the lifetime is 11 +8, -7 fs.Comment: 6 pages, submitted to Phys. Rev.

Lifetimes of states in 19Ne above the 15 O + alpha breakup threshold

The 15O(alpha,gamma)19Ne reaction plays a role in the ignition of Type I x-ray bursts on accreting neutron stars. The lifetimes of states in 19Ne above the 15O + alpha threshold of 3.53 MeV are important inputs to calculations of the astrophysical reaction rate. These levels in 19Ne were populated in the 3He(20Ne,alpha)19Ne reaction at a 20Ne beam energy of 34 MeV. The lifetimes of six states above the threshold were measured with the Doppler shift attenuation method (DSAM). The present measurements agree with previous determinations of the lifetimes of these states and in some cases are considerably more precise

Discovery of Yttrium, Zirconium, Niobium, Technetium, and Ruthenium Isotopes

Currently, thirty-four yttrium, thirty-five zirconium, thirty-four niobium, thirty-five technetium, and thirty-eight ruthenium isotopes have been observed and the discovery of these isotopes is discussed here. For each isotope a brief synopsis of the first refereed publication, including the production and identification method, is presented.Comment: To be published in Atomic Data and Nuclear Data Table

Rheumatoid arthritis - treatment: 180. Utility of Body Weight Classified Low-Dose Leflunomide in Japanese Rheumatoid Arthritis

Background: In Japan, more than 20 rheumatoid arthritis (RA) patients died of interstitial pneumonia (IP) caused by leflunomide (LEF) were reported, but many of them were considered as the victims of opportunistic infection currently. In this paper, efficacy and safety of low-dose LEF classified by body weight (BW) were studied. Methods: Fifty-nine RA patients were started to administrate LEF from July 2007 to July 2009. Among them, 25 patients were excluded because of the combination with tacrolimus, and medication modification within 3 months before LEF. Remaining 34 RA patients administered 20 to 50 mg/week of LEF were followed up for 1 year and enrolled in this study. Dose of LEF was classified by BW (50 mg/week for over 50 kg, 40 mg/week for 40 to 50 kg and 20 to 30 mg/week for under 40 kg). The average age and RA duration of enrolled patients were 55.5 years old and 10.2 years. Prednisolone (PSL), methotrexate (MTX) and etanercept were used in 23, 28 and 2 patients, respectively. In case of insufficient response or adverse effect, dosage change or discontinuance of LEF were considered. Failure was defined as dosages up of PSL and MTX, or dosages down or discontinuance of LEF. Last observation carried forward method was used for the evaluation of failed patients at 1 year. Results: At 1 year after LEF start, good/ moderate/ no response assessed by the European League Against Rheumatism (EULAR) response criteria using Disease Activity Score, including a 28-joint count (DAS28)-C reactive protein (CRP) were showed in 14/ 10/ 10 patients, respectively. The dosage changes of LEF at 1 year were dosage up: 10, same dosage: 5, dosage down: 8 and discontinuance: 11 patients. The survival rate of patients in this study was 23.5% (24 patients failed) but actual LEF continuous rate was 67.6% (11 patients discontinued) at 1 year. The major reason of failure was liver dysfunction, and pneumocystis pneumonia was occurred in 1 patient resulted in full recovery. One patient died of sepsis caused by decubitus ulcer infection. DAS28-CRP score was decreased from 3.9 to 2.7 significantly. Although CRP was decreased from 1.50 to 0.93 mg/dl, it wasn't significant. Matrix metalloproteinase (MMP)-3 was decreased from 220.0 to 174.2 ng/ml significantly. Glutamate pyruvate transaminase (GPT) was increased from 19 to 35 U/l and number of leukocyte was decreased from 7832 to 6271 significantly. DAS28-CRP, CRP, and MMP-3 were improved significantly with MTX, although they weren't without MTX. Increase of GPT and leukopenia were seen significantly with MTX, although they weren't without MTX. Conclusions: It was reported that the risks of IP caused by LEF in Japanese RA patients were past IP history, loading dose administration and low BW. Addition of low-dose LEF is a potent safe alternative for the patients showing unsatisfactory response to current medicines, but need to pay attention for liver function and infection caused by leukopenia, especially with MTX. Disclosure statement: The authors have declared no conflicts of interes