Clinical profile of recent progressive illnesses in patients with mucormycosis: a comprehensive analysis

Background: The COVID-19 pandemic, in its omnipresence, descended an unprecedented blow on the reeling facilities nationwide, which at its stabilising junction posed another threat – mucormycosis. Potentially immunodeficient cases, diabetes and excessive rampancy of steroids propagated this neo-epidemic, currently challenging the fretting mortality rate. Aim of the study was to analyse the clinical profile elaborating the recent illnesses and progression in patients admitted with mucormycosis in a dedicated ‘mucor-care’ centre.Methods: Total 195 admitted patients were evaluated based on their COVID protocol management and oxygen therapy administered with special emphasis on hygiene maintenance in view of mask support, oral care and hospitalisation course with duration and medications provided. Type and duration of glucocorticoids, injectable or oral, dispensed to the patients were duly logged and analysed.Results: Half cases (50%) were found COVID reverse transcriptase-polymerase chain reaction (RT-PCR) positive with 69% patients suffering from moderate ailment and above. Patients averaged 25-30 days at onset of post-COVID mucormycosis symptomatology with 78% (172) cases having h/o hospitalisation. 90% patients required oxygen therapy in variable magnitudes with meagre 38% receiving ‘remdesivir’ complete course dosages. Despite being prudent, 58% did not maintain adequate sanitation while 72% denied having oxygen humidified. Steroids were pivotal with 84% affirmative prevalence; dexamethasone being commonest, averaging 15 days of therapy, which supplementing immune-compromised modalities, promulgated this epidemic.Conclusions: The deadly trinity of diabetes, rampancy of steroids in a background of COVID-19 caused havoc in recent times. Only astute usage of resources and prudent education can curb this menace in a better way.

A rare presentation of snake bite

In India, doctor’s in casualty frequently get confronted with snake bite. A wide range of complications occur in snake bite. Intracerebral haemorrhage (ICH) is an unusual presentation following snake bite. Here authors discuss a patient presents with ICH after snake bite. Venom induced consumption coagulopathy is the most accepted theory behind intracerebral haemorrhage

Study of the correlation of epicardial adipose tissue with left ventricular mass and left ventricular mass index in patients with essential hypertension

Background: Epicardial Adipose Tissue (EAT) is recognized to be a cardiovascular risk factor. In addition to providing fuel to heart, it plays a pivotal role in the pathogenesis of atherosclerosis though the secretion of adipokines. This study aims to find the correlation of EAT with Left Ventricular Mass (LVM) and Left Ventricular Mass Index (LVMI) in patients with essential hypertension. Increasing LVM and LVMI are predictors of poor cardiovascular outcome. So, if we find a positive correlation, we can say that measurement of epicardial fat in essential hypertension may help us identify high risk hypertensive patients.Methods: This study was carried out in SMS Hospital, Jaipur, after approval from the Ethics Committee. 100 consecutive eligible patients were included in the study after application of inclusion and exclusion criteria and taking proper informed consent. After history, examination and routine laboratory investigations, all patients underwent transthoracic 2D and Doppler echocardiography. EAT thickness, LVM and LVMI were measured and correlated using Spearman correlation coefficient.Results: The mean LVM was 139±42.12 g and mean LVMI was 35.76±11.28 g/m2.7. The spearman correlation coefficient (r) was calculated to be 0.691 between EAT and LVM and 0.677 between EAT and LVMI, indicating strong positive correlation between EAT and both LVM and LVMI. This implies that as; EAT increases, LVM and LVMI increases significantly.Conclusions: Thus, authors have found that EAT is positively correlated with LVM and LVMI. So, we can say that increase in EAT may lead to adverse cardiovascular outcome in patients with essential hypertension

Use of viral promoters in mammalian cell-based bioassays: How reliable?

Cell-based bioassays have been suggested for screening of hormones and drug bioactivities. They are a plausible alternative to animal based methods. The technique used is called receptor/reporter system. Receptor/reporter system was initially developed as a research technique to understand gene function. Often reporter constructs containing viral promoters were used because they could be expressed with very 'high' magnitude in a variety of cell types in the laboratory. On the other hand mammalian genes are expressed in a cell/tissue specific manner, which makes them (i.e. cells/tissues) specialized for specific function in vivo. Therefore, if the receptor/reporter system is to be used as a cell-based screen for testing of hormones and drugs for human therapy then the choice of cell line as well as the promoter in the reporter module is of prime importance so as to get a realistic measure of the bioactivities of 'test' compounds. We evaluated two conventionally used viral promoters and a natural mammalian promoter, regulated by steroid hormone progesterone, in a cell-based receptor/reporter system. The promoters were spliced into vectors expressing enzyme CAT (chloramphenicol acetyl transferase), which served as a reporter of their magnitudes and consistencies in controlling gene expressions. They were introduced into breast cell lines T47D and MCF-7, which served as a cell-based source of progesterone receptors. The yardstick of their reliability was highest magnitude as well as consistency in CAT expression on induction by sequential doses of progesterone. All the promoters responded to induction by progesterone doses ranging from 10(-12 )to 10(-6 )molar by expressing CAT enzyme, albeit with varying magnitudes and consistencies. The natural mammalian promoter showed the most coherence in magnitude as well as dose dependent expression profile in both the cell lines. Our study casts doubts on use of viral promoters in a cell-based bioassay for measuring bioactivities of drugs and hormones for human therapy and suggests caution regardingtranslation in toto, of a research technique as a cell-based bioassay for drug screening

Diastema-The Treatment Dilemma

Spacing between adjacent teeth is known as Diastema, many of the patients seek closure of diastema for aesthetic reasons. Diastema less than 2 mm close spontaneously ,if they do not do so then they should not be straightaway corrected rather a thorough clinical and radiographic examination should done to  determine the underlying cause and to rule out anomalies, such as the presence of any supernumerary  tooth or odontoma’s which should be ruled out before going on for orthodontic therapy. The purpose of this article is to present and discuss the case of a 9-year old child with the chief complaint of spacing between the maxillary right permanent central incisor and right permanent lateral incisor. Radioopaque calcified masses were seen in the radiograph and was diagnosed with compound odontome followed by the surgical removal of the calcified masses

Building better healthcare – technologies to facilitate evidence-based design processes

Building better healthcare – technologies to facilitate evidence-based design processe

Genome-wide transcriptome study in wheat identified candidate genes related to processing quality, majority of them showing interaction (quality x development) and having temporal and spatial distributions

BACKGROUND: The cultivated bread wheat (Triticum aestivum L.) possesses unique flour quality, which can be processed into many end-use food products such as bread, pasta, chapatti (unleavened flat bread), biscuit, etc. The present wheat varieties require improvement in processing quality to meet the increasing demand of better quality food products. However, processing quality is very complex and controlled by many genes, which have not been completely explored. To identify the candidate genes whose expressions changed due to variation in processing quality and interaction (quality x development), genome-wide transcriptome studies were performed in two sets of diverse Indian wheat varieties differing for chapatti quality. It is also important to understand the temporal and spatial distributions of their expressions for designing tissue and growth specific functional genomics experiments. RESULTS: Gene-specific two-way ANOVA analysis of expression of about 55 K transcripts in two diverse sets of Indian wheat varieties for chapatti quality at three seed developmental stages identified 236 differentially expressed probe sets (10-fold). Out of 236, 110 probe sets were identified for chapatti quality. Many processing quality related key genes such as glutenin and gliadins, puroindolines, grain softness protein, alpha and beta amylases, proteases, were identified, and many other candidate genes related to cellular and molecular functions were also identified. The ANOVA analysis revealed that the expression of 56 of 110 probe sets was involved in interaction (quality x development). Majority of the probe sets showed differential expression at early stage of seed development i.e. temporal expression. Meta-analysis revealed that the majority of the genes expressed in one or a few growth stages indicating spatial distribution of their expressions. The differential expressions of a few candidate genes such as pre-alpha/beta-gliadin and gamma gliadin were validated by RT-PCR. Therefore, this study identified several quality related key genes including many other genes, their interactions (quality x development) and temporal and spatial distributions. CONCLUSIONS: The candidate genes identified for processing quality and information on temporal and spatial distributions of their expressions would be useful for designing wheat improvement programs for processing quality either by changing their expression or development of single nucleotide polymorphisms (SNPs) markers

Lopinavir/ritonavir: is early administration better in Covid-19?

Background: To share the data of coronavirus 2019 (Covid-19) patients started on lopinavir-ritonavir (lopi/r) in relation to time period from the onset of symptoms.Method: Observational descriptive study of 23 Covid-19 patients admitted in a tertiary care center in India from March 2020 to May 2020. Patients categorized into 2 groups based on the timing of initiation of lopi/r from the onset of symptoms. Group 1 were given the drug early (≤7 days) and group 2 late (>7 days). The clinical events (oxygen requirement days and ICU stay) and outcomes of hospital stay between the two groups were evaluated.Results: Patients were started on lopi/r for a period of 14 days on admission, out of which 12 patients were in group 1 and 11 patients in group 2. Underlying co-morbidities were present in 15 patients (65.21%). The mean duration from onset of symptoms to lopi/r initiation was 4 days and 11.1 days in Group 1 and 2 respectively. Requirement for oxygen support (2.16 versus 6.54 days), mean duration of hospitalization (8.58 versus 11.54 days) and mean duration of obtaining first Covid-19 negative report from the onset of symptoms (10.5 versus 19.57 days) were all significantly lesser in group 1 (p<0.05). All patients belonging to Group 1 and eight patients of group 2 recovered completely and were discharged whereas 3 patients of group 2 expired. Diarrhea was the most commonly observed adverse effect of lopi/r in our patients.Conclusion: With no approved weapon to tackle the Covid-19 pandemic, we should keep lopi/r in our armamentarium of drugs and use it at the earliest. More clinical trials are needed in future to ascertain if lopi/r can reduce hospital stay, prompt faster recovery and result in better clinical outcome