Different Faces of HIV in a Single Patient

Opportunistic infections (OIs) are a major cause of morbidity and mortality in patients with human immunodeficiency virus (HIV) infection. The most common opportunistic infection is tuberculosis, followed by candidiasis, infections causing diarrhoea, and pneumocystis carinii pneumonia (PCP). We hereby report the case of a 34-year-old male with clinical stage-IV acquired immunodeficiency syndrome (AIDS) who had multiple OIs including visceral leishmaniasis (VLs) an uncommon co-infection in the Indian scenario. This patient also had features of multiple pulmonary infections-bacterial, mycobacterial and fungal, a rare clinical problem in HIV

Appraisal of Noise Level Dissemination Surrounding Mining and Industrial Areas of Keonjhar, Odisha: a Comprehensive Approach Using Noise Mapping

Noise mapping is a well-established practice among the European nations, and it has been following for almost two decades. Recently, as per guidelines of the Directorate General of Mines Safety (DGMS), India, noise mapping has made mandatory in the mining expanses. This study is an effort made to map the noise levels in nearby areas of mines in the northern Keonjhar district. The motive of this study is to quantify the existing A-weighted time-average sound level (LAeq,T) in the study area to probe its effects on the human dwellings and noise sensitive areas with the probability of future development of the mines, roads and industrial & commercial zone. The LAeq,T was measured at 39 identified locations, includes industrial, commercial, residential and sensitive zones, 15 open cast mines, 3 major highways and 3 haulage roads. With the utilization of Predictor LimA Software and other GIS tools, the worked out data is mapped and noise contours are developed for the visualization and identification of the extent and distribution of sound levels across the study area. This investigation discloses that the present noise level at 60% of the locations in silence and residential zone are exposed to significantly high noise levels surpasses the prescribed limit of Central Pollution Control Board (CPCB), India. The observed day and night time LAeq,T level of both the zone, ranged between 43.2 - 62.2 dB (A) and 30.5 – 53.4 dB (A) respectively whereas, the average Ldn values vary between 32.7 – 51.2 dB (A). The extensive mobility of heavy vehicles adjoining the sensitive areas and a nearby plethora of open cast mines is the leading cause of exceeded noise levels. The study divulges that the delicate establishments like school and hospitals are susceptible to high noise levels throughout the day and night. A correlation between observed and software predicted values gives R2 of 0.605 for Ld; 0.217 for Ln; and 0.524 for Ldn. Finally, the mitigation measure proposed and demonstrated using contour map showing a significant reduction in the noise levels by 0 – 5.3 dB (A)

Validation of a noninvasive aMMP-8 point-of-care diagnostic methodology in COVID-19 patients with periodontal disease

Objectives: The aim of this study was to validate an active matrix metalloproteinase (MMP-8) point-of-care diagnostic tool in COVID-19 patients with periodontal disease. Subjects, Materials, and Methods: Seventy-two COVID-19-positive and 30 COVID-19-negative subjects were enrolled in the study. Demographic data were recorded, periodontal examination carried out, and chairside tests run for evaluating the expression of active MMP-8 (aMMP-8) in the site with maximum periodontal breakdown via gingival crevicular fluid sampling as well as via a mouth rinse-based kit for general disease activity. In COVID-19-positive patients, the kits were run again once the patients turned COVID-19 negative. Results: The overall (n = 102) sensitivity/specificity of the mouthrinse-based kits to detect periodontal disease was 79.41%136.76% and that of site-specific kits was 64.71%/55.88% while adjusting for age, gender, and smoking status increased the sensitivity and specificity (82.35%/76.47% and 73.53%/88.24, respectively). Receiver operating characteristic (ROC) analysis for the adjusted model revealed very good area under the ROC curve 0.746-0.869 (p < .001) and 0.740-0.872 (p < .001) (the aMMP-8 mouth rinse and site-specific kits, respectively). No statistically significant difference was observed in the distribution of results of aMMP-8 mouth rinse test (p = .302) and aMMP-8 site-specific test (p = .189) once the subjects recovered from COVID-19. Conclusions: The findings of the present study support the aMMP-8 point-of-care testing (PoCT) kits as screening tools for periodontitis in COVID-19 patients. The overall screening accuracy can be further increased by utilizing adjunctively risk factors of periodontitis. The reported noninvasive, user-friendly, and objective PoCT diagnostic methodology may provide a way of stratifying risk groups, deciding upon referrals, and in the institution of diligent oral hygiene regimens.Peer reviewe

Sudden changes in fluvial style across the Permian / Triassic boundary in the eastern Iberian Ranges, Spain: Analysis of possible causes

The sedimentary record of the Late Permian and Early Triassic of the eastern Iberian Ranges shows four major, sudden, or very rapid, vertical changes in fluvial style. The Late Permian sedimentary cycle starts with the Boniches Formation, of alluvial fan-braided fluvial origin, which grades vertically over within a few metres into the Alcotas Formation, deposited by low to high sinuosity, avulsion-prone rivers with extensive floodplains. The Alcotas Formation contains calcimorphic soils, plant remains and pollen and spore assemblages. However, the upper third of the unit is devoid of all organic remains and soils and is characterized by a dominant red colour, the sandstone levels were deposited by high-sinuosity, meandering rivers. This major change took place during the Late Permian and is probably coeval with the emplacement of the Emeishan basaltic Large Igneous Province (LIP) in SE China. Rocks of the Boniches and Alcotas Formations are separated by an angular unconformity from the overlying strata, which consist of the Late Permian conglomeratic Hoz del Gallo Formation, of alluvial fan–gravel braided fluvial origin and the sandy Cañizar Formation, of low-sinuosity sandy river origin. The Permian– Triassic boundary lies, probably between the upper part of the Hoz del Gallo Formation and the first metres of the Cañizar Formation. Late Permian pollen and spore assemblages have been found in the Hoz del Gallo Formation but the Cañizar Formation is barren, with the exception of an Anisian (Middle Triassic) assemblage at the top. Tectonic extensional pulses in the Iberian Basin caused the changes observed between the lower and upper parts of the Boniches Formation, at the base of the Hoz del Gallo Formation and between the lower and upper part of this Formation. The changes observed in the uppermost part of the Alcotas Formation are not easily explained by tectonic causes, nor those in the passage from the Hoz del Gallo Formation to the Cañizar Formation. Similar sedimentary characteristics of the sandy Cañizar Formation such as amalgamated sandstone bodies, erosion and reactivation surfaces, dominant trough cross-stratification, tabular geometry, absence of plant remains and pollen and spores, and absence of silts and clays to those of coeval formations in places as far away as Australia, South Africa and Brazil suggest a global rather than local cause for these abrupt changes in fluvial style. This global cause was probably die-off of plant cover over extensive areas of the catchment, related to the end of the Permian mass extinction and possibly related to the emplacement of the West Siberian basaltic Large Igneous Province (LIP), responsible for drastic atmospheric and marine changes

Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic

Introduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children &lt;18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p&lt;0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p&lt;0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p&lt;0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer

Pancytopenia in Cytophagic Histiocytic Panniculitis - Case Report

Cytophagic histiocytic panniculitis (CHP) is a rare subtype of panniculitis that usually follows a fatal course, with a terminal hemophagocytic syndrome. We observed a case of pancytopenia, generalized lymphadenopathy and panniculitis, which on subsequent investigations (skin biopsy and bone marrow biopsy) revealed hemophagocytic and cytophagocytic picture