Predictors of Mucormycosis in COVID-19

Background and Aims: Mucormycosis, a serious angioinvasive infection caused by common filamentous fungi, that is, mucormycetes, constitutes the third most common invasive fungal infection, following aspergillosis and candidiasis. Although a rare infection, in recent times we witnessed a sudden surge of mucormycosis cases post-COVID-19 (coronavirus disease 2019). The present study was carried out to understand its relation to COVID-19, inflammatory markers, steroid use during COVID-19 treatment, clinical course and outcome of the disease. Material and methods: The present study was conducted at RNT Medical College, Udaipur over a period of 1 month. Written and informed consent from patients were taken. In this study, 15 patients admitted in COVID wards, medical wards, muormycosis ward and ICU were included if fungal hyphae were found on potassium hydroxide (KOH) mount and there was a history of COVID-19 illness; negative KOH mount patients were excluded. Results: In the present study, on admission, out of 15 patients, 7 (46.7%) were admitted with mean neutrophil-to-lymphocyte ratio (NLR) >5.5, mean C-reactive protein (CRP) 126, mean interleukin (IL)-6 82.4, mean lactate dehydrogenase (LDH) 528, mean ferritin 662, mean D-dimer 1760; 5 (33.3%) patients were admitted with mean NLR 3.5-5.5, mean CRP 68, mean IL-6 39.6, mean LDH 336, mean ferritin 448, mean D-dimer 780; and 3 (20%) patients were admitted with mean NLR <3.5, mean CRP 16, mean IL-6 12.8, mean LDH 172, mean ferritin 226, mean D-dimer 430. Out of the 7 patients who were admitted with NLR >5.5, 3 (42.8%) were admitted with orbital cellulitis and 4 (57.2%) with invasive sinusitis. Out of 5 patients admitted with NLR 3.5-5.5, 3 (60%) were admitted with orbital cellulitis and 2 (40%) with invasive sinusitis. Out of 3 patients admitted with NLR <3.5, 1 (33.3%) patient had orbital cellulitis and 2 (66.7%) had invasive sinusitis. Out of total 7 patients who were admitted with orbital cellulitis, in 71.4% patients, steroid was used during COVID-19 treatment and out of 8 patients who were admitted with invasive sinusitis, in 62.5% patients, steroid was used during COVID-19 treatment. In the present study, 68% patients were male and 32% were female. Around 78% patients were from rural area and 22% patients were from urban area. Overall, 74% cases were treated with amphotericin B. Among these, 36% cases were diagnosed with orbital cellulitis and 38% cases were diagnosed with invasive sinusitis. Around 26% cases were treated with posaconazole, and among these 9% were orbital cellulitis cases and 17% were invasive sinusitis cases. About 85.72% cases of orbital cellulitis and 75% cases of invasive sinusitis improved. Nearly 42.86% cases who were admitted with NLR >5.5 did not improve with treatment. Conclusion: As per present study, inflammatory markers of COVID-19, NLR and history of steroid use during treatment can be considered as predictors of mucormycosis occurrence and their outcom

Operation of Circuit Breaker with the help of Password

A circuit breaker is an electrical switch use to protect an electrical circuit from damage caused by faults. Its basic function is to detect a fault condition and protect from it. Fuse operates once after that it must be replaced but a circuit breaker can be reset to resume normal condition. During the manual operation, we see inoperable electrical accidents to the line man are rises during maintenance due to improper communication between the maintenance staff and the substation staff. In order to prevent such accidents, password based circuit breaker is design so that only authentic person can operate it with a password. There is also a facility of changing the password. The system is fully controlled by the microcontroller. The password is saved in an EEPROM, interfaced to the microcontroller and the password can be changed any time. A keypad is used to submit the password and a relay to operate circuit breaker, which is indicated by a bulb. Any wrong attempt to open the circuit breaker by entering the wrong password an alert will be shown in the LCD

Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions

BACKGROUND: Good outcomes during pregnancy and childbirth are related to availability, utilisation and effective implementation of essential interventions for labour and childbirth. The majority of the estimated 289,000 maternal deaths, 2.8 million neonatal deaths and 2.6 million stillbirths every year could be prevented by improving access to and scaling up quality care during labour and birth. METHODS: The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for skilled birth attendance and basic and comprehensive emergency obstetric care. RESULTS: Across 12 countries the most critical bottlenecks identified by workshop participants for skilled birth attendance were health financing (10 out of 12 countries) and health workforce (9 out of 12 countries). Health service delivery bottlenecks were found to be the most critical for both basic and comprehensive emergency obstetric care (9 out of 12 countries); health financing was identified as having critical bottlenecks for comprehensive emergency obstetric care (9 out of 12 countries). Solutions to address health financing bottlenecks included strengthening national financing mechanisms and removing financial barriers to care seeking. For addressing health workforce bottlenecks, improved human resource planning is needed, including task shifting and improving training quality. For health service delivery, proposed solutions included improving quality of care and establishing public private partnerships. CONCLUSIONS: Progress towards the 2030 targets for ending preventable maternal and newborn deaths is dependent on improving quality of care during birth and the immediate postnatal period. Strengthening national health systems to improve maternal and newborn health, as a cornerstone of universal health coverage, will only be possible by addressing specific health system bottlenecks during labour and birth, including those within health workforce, health financing and health service delivery

Scaling up quality care for mothers and newborns around the time of birth: an overview of methods and analyses of intervention-specific bottlenecks and solutions.

BACKGROUND: The Every Newborn Action Plan (ENAP) and Ending Preventable Maternal Mortality targets cannot be achieved without high quality, equitable coverage of interventions at and around the time of birth. This paper provides an overview of the methodology and findings of a nine paper series of in-depth analyses which focus on the specific challenges to scaling up high-impact interventions and improving quality of care for mothers and newborns around the time of birth, including babies born small and sick. METHODS: The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the ENAP process. Country workshops engaged technical experts to complete a tool designed to synthesise "bottlenecks" hindering the scale up of maternal-newborn intervention packages across seven health system building blocks. We used quantitative and qualitative methods and literature review to analyse the data and present priority actions relevant to different health system building blocks for skilled birth attendance, emergency obstetric care, antenatal corticosteroids (ACS), basic newborn care, kangaroo mother care (KMC), treatment of neonatal infections and inpatient care of small and sick newborns. RESULTS: The 12 countries included in our analysis account for the majority of global maternal (48%) and newborn (58%) deaths and stillbirths (57%). Our findings confirm previously published results that the interventions with the most perceived bottlenecks are facility-based where rapid emergency care is needed, notably inpatient care of small and sick newborns, ACS, treatment of neonatal infections and KMC. Health systems building blocks with the highest rated bottlenecks varied for different interventions. Attention needs to be paid to the context specific bottlenecks for each intervention to scale up quality care. Crosscutting findings on health information gaps inform two final papers on a roadmap for improvement of coverage data for newborns and indicate the need for leadership for effective audit systems. CONCLUSIONS: Achieving the Sustainable Development Goal targets for ending preventable mortality and provision of universal health coverage will require large-scale approaches to improving quality of care. These analyses inform the development of systematic, targeted approaches to strengthening of health systems, with a focus on overcoming specific bottlenecks for the highest impact interventions

Purkinje cell loss in experimental autoimmune encephalomyelitis

Gray matter atrophy observed by brain MRI is an important correlate to clinical disability and disease duration in multiple sclerosis. The objective of this study was to link brain atrophy visualized by neuroimaging to its underlying neuropathology using the MS model, experimental autoimmune encephalomyelitis (EAE). Volumetric changes in brains of EAE mice, as well as matched healthy normal controls, were quantified by collecting post-mortem high-resolution T2-weighted magnetic resonance microscopy and actively stained magnetic resonance histology images. Anatomical delineations demonstrated a significant decrease in the volume of the whole cerebellum, cerebellar cortex, and molecular layer of the cerebellar cortex in EAE as compared to normal controls. The pro-apoptotic marker caspase-3 was detected in Purkinje cells and a significant decrease in Purkinje cell number was found in EAE. Cross modality and temporal correlations revealed a significant association between Purkinje cell loss on neuropathology and atrophy of the molecular layer of the cerebellar cortex by neuroimaging. These results demonstrate the power of using combined population atlasing and neuropathology approaches to discern novel insights underlying gray matter atrophy in animal models of neurodegenerative disease

The influence of the terminal acceptor and oligomer length on the photovoltaic properties of A–D–A small molecule donors

Four new A–D–A small molecules (denoted as FG1–4) have been designed and synthesized. The compounds have cyclopentadithiophene-vinylene (CPDTV) oligomers of different lengths as the central donor core linked with different terminal acceptor units (3-ethylrhodanine or dicyanomethylene-3-ethylrhodanine). The effects that conjugation length and terminal acceptor units have on the optical and electrochemical properties were investigated. These small molecules were used as donors in conjunction with PC71BM as an acceptor in the bulk heterojunction active layer for the fabrication of solution-processed organic solar cells. Solvent vapor annealing treatment improved the crystallinity and the interpenetrating networks of donor and acceptor phases for exciton dissociation and charge transfer, thus leading to significant improvements in the overall power conversion efficiency (PCE) of the organic solar cells. The PCE values for the organic solar cells based on the optimized FG1:PC71BM, FG2:PC71BM, FG3:PC71BM and FG4:PC71BM active layer were 5.58%, 6.99%, 7.51% and 8.43%, respectively. These results indicate that an enhancement in the PCE of small molecule organic solar cells can be achieved by an increase in conjugation-length and variation of terminal acceptor units in the molecular backbone of small molecules and optimization of the crystallinity and nanoscale interpenetrating morphology by appropriate solvent vapor annealing treatment