Cutaneous mastocytosis. Getting beneath the skin of the issue: a case report

An eleven month old girl presented with chronic urticaria since three months of age. There was a generalised hyperpigmented maculo-papular rash. Darier sign was positive. The skin biopsy showed plenty of spindle shaped mast cells with eosinophilic cytoplasm infiltrating the dermis and the appendiceal structures. The diagnosis of cutaneous mastocytosis (urticaria pigmentosa) was made. The child received symptomatic relief with chronic oral hydroxyzine and ranitidine therapy. Automated epinephrine self-injectors usually prescribed in this condition for self-management of anaphylactic episodes were not available. Intramuscular administration of (1:1000) diluted adrenaline via a disposable tuberculin syringe was taught to the mother. A medical bracelet containing her diagnosis and instructions in emergency was custom-made for her

A prospective study on emergence of mucormycosis in recently recovered COVID-19 patients

Background: Mucormycosis is an angio-invasive fungal infection with high morbidity and mortality.  This infection seems to be increasing during the second wave of COVID-19. Objectives of this study were to identify and characterise the fungal species causing post-covid-mycosis, to analyze the cases for underlying co-morbidities if any and to correlate the associated risk factors with the progression of disease. Methods: Prospective observational study which constituted conventional fungal culture of 188 tissue specimens collected from clinically suspected mucormycosis patients who had history of COVID. Results: This study noted the occurrence of disease with predominance of males (72.03%). Most common symptoms were facial/periorbital swelling, followed by facial pain and headache. Among co-morbid conditions, diabetes mellitus was the most common (71.17%). Use of steroids (65.25%), antivirals therapy (22.86%), oxygen support (11.86%) used in management of COVID patients were found to be risk factors in post-covid-mucormycosis. radiological diagnosis showed involvement of paranasal sinuses (77.11%), followed by orbit (16.94%) and brain (5.90%). Mucor spp. was isolated in 21 cases. Although commonest fungus isolated was Aspergillus, analysis of the data for last 5 years showed a significant rise of Mucormycosis cases. Mortality was seen in 17.79% cases. Conclusions: Fungal aetiology should be kept in mind in patients with above clinical presentations with history of recent COVID-19 infection especially who received steroids

Association of respiratory symptoms and lung function with occupation in the multinational Burden of Obstructive Lung Disease (BOLD) study

Background Chronic obstructive pulmonary disease has been associated with exposures in the workplace. We aimed to assess the association of respiratory symptoms and lung function with occupation in the Burden of Obstructive Lung Disease study. Methods We analysed cross-sectional data from 28 823 adults (≥40 years) in 34 countries. We considered 11 occupations and grouped them by likelihood of exposure to organic dusts, inorganic dusts and fumes. The association of chronic cough, chronic phlegm, wheeze, dyspnoea, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1)/FVC with occupation was assessed, per study site, using multivariable regression. These estimates were then meta-analysed. Sensitivity analyses explored differences between sexes and gross national income. Results Overall, working in settings with potentially high exposure to dusts or fumes was associated with respiratory symptoms but not lung function differences. The most common occupation was farming. Compared to people not working in any of the 11 considered occupations, those who were farmers for ≥20 years were more likely to have chronic cough (OR 1.52, 95% CI 1.19–1.94), wheeze (OR 1.37, 95% CI 1.16–1.63) and dyspnoea (OR 1.83, 95% CI 1.53–2.20), but not lower FVC (β=0.02 L, 95% CI −0.02–0.06 L) or lower FEV1/FVC (β=0.04%, 95% CI −0.49–0.58%). Some findings differed by sex and gross national income. Conclusion At a population level, the occupational exposures considered in this study do not appear to be major determinants of differences in lung function, although they are associated with more respiratory symptoms. Because not all work settings were included in this study, respiratory surveillance should still be encouraged among high-risk dusty and fume job workers, especially in low- and middle-income countries.publishedVersio

Cohort Profile: Burden of Obstructive Lung Disease (BOLD) study

The Burden of Obstructive Lung Disease (BOLD) study was established to assess the prevalence of chronic airflow obstruction, a key characteristic of chronic obstructive pulmonary disease, and its risk factors in adults (≥40 years) from general populations across the world. The baseline study was conducted between 2003 and 2016, in 41 sites across Africa, Asia, Europe, North America, the Caribbean and Oceania, and collected high-quality pre- and post-bronchodilator spirometry from 28 828 participants. The follow-up study was conducted between 2019 and 2021, in 18 sites across Africa, Asia, Europe and the Caribbean. At baseline, there were in these sites 12 502 participants with high-quality spirometry. A total of 6452 were followed up, with 5936 completing the study core questionnaire. Of these, 4044 also provided high-quality pre- and post-bronchodilator spirometry. On both occasions, the core questionnaire covered information on respiratory symptoms, doctor diagnoses, health care use, medication use and ealth status, as well as potential risk factors. Information on occupation, environmental exposures and diet was also collected

Microbial assessment of dental unit waterlines in an institutional setup in Karnataka, South India

Background and Aim: Biofilms in dental unit waterlines (DUWLs), suction hoses, and fittings are a potentially significant source of cross-contamination posing significant health risk as these may come into contact with patients during treatment. The purpose of this in vitro study was to identify the spectrum of bacterial flora colonizing the DUWLs and to detect pathogenic microorganisms present in such an environmental niche. Materials and Methods: Thirty DUWL samples were collected from in use dental units selected randomly from various clinical departments. Samples were collected from the following devices; 3-in-1 syringe waterline, section of waterline tubing supplying the 3-in-1 syringe, and the air rotor water. The samples were subjected to bacteriological analysis, and all bacterial isolates were tested for their ability to form biofilms. Results: A descriptive analysis of the results obtained was carried out, and it was observed that 7 out of 30 (23.3%) samples collected from DUWL were supplying water of unsatisfactory quality with species of low-pathogenicity bacteria isolated present in significant numbers; four of ten (40%) water supply lines contained bacterial biofilms; and the species with greatest capability to form biofilms were Enterobacter species (spp.). In addition, the results were also subjected to Chi-square test which revealed no statistical difference between the species and the location of collection of samples. Conclusion: Within the limitations of this study, it is concluded that DUWLs are not totally free of contamination. Microbial biofilms are a significant source of cross-contamination and cross-infection in the dental clinic environment

Left ventricular noncompaction: A cardiomyopathy often mistaken

Left ventricular noncompaction (LVNC) is a rare genetic cardiomyopathy postulated to be a defect in endomyocardial morphogenesis due to the embryonic arrest of the compaction of myocardial fibers. It could be isolated, without other structural heart defects; or associated with congenital heart defects. It is characterized by prominent ventricular myocardial trabeculations and deep intertrabecular recesses. The clinical manifestations, i.e., heart failure, arrhythmias or thromboembolism, overlap with those of other cardiac disorders. It is often misdiagnosed as restrictive or dilated cardiomyopathy. The high mortality and morbidity associated with it and familial occurrence make diagnosis important. Only 3 pediatric cases have been reported from India. We present 2 cases, that of an 11-year-old girl (familial case) with embolism (documented but rare in children) and atrial flutter (not yet reported), with mother having asymptomatic LVNC; and that of a 4-month-old girl. Both presented with heart failure. The 11-year-old child had sudden death, known to occur in LVNC

Overdiagnosis of COPD in subjects with unobstructed spirometry

Background: There are several reports on the underdiagnosis of COPD, while little is known about COPD overdiagnosis and overtreatment. We describe the overdiagnosis and the prevalence of spirometrically defined false-positive COPD, as well as their relationship with overtreatment across 23 population samples in 20 countries participating in the BOLD Study between 2003 and 2012. Methods: A false-positive diagnosis of COPD was considered when participants reported a doctor's diagnosis of COPD, but postbronchodilator spirometry was unobstructed (FEV1/FVC > LLN). Additional analyses were performed using the fixed ratio criterion (FEV1/FVC < 0.7). Results: Among 16,177 participants, 919 (5.7%) reported a previous medical diagnosis of COPD. Postbronchodilator spirometry was unobstructed in 569 subjects (61.9%): false-positive COPD. A similar rate of overdiagnosis was seen when using the fixed ratio criterion (55.3%). In a subgroup analysis excluding participants who reported a diagnosis of "chronic bronchitis" or "emphysema" (n = 220), 37.7% had no airflow limitation. The site-specific prevalence of false-positive COPD varied greatly, from 1.9% in low- to middle-income countries to 4.9% in high-income countries. In multivariate analysis, overdiagnosis was more common among women, and was associated with higher education; former and current smoking; the presence of wheeze, cough, and phlegm; and concomitant medical diagnosis of asthma or heart disease. Among the subjects with false-positive COPD, 45.7% reported current use of respiratory medication. Excluding patients with reported asthma, 34.4% of those with normal spirometry still used a respiratory medication. Conclusions: False-positive COPD is frequent. This might expose nonobstructed subjects to possible adverse effects of respiratory medication.info:eu-repo/semantics/publishedVersio