Decreased mortality in coronavirus disease 2019 associated mucormycosis with aspirin use: a retrospective cohort study.

OBJECTIVE: Rhino-orbito-cerebral mucormycosis is a rapidly progressive disease with high mortality rates of about 60 per cent. The increasing incidence of rhino-orbito-cerebral mucormycosis in coronavirus disease 2019 patients in India and worldwide has become a matter of concern owing to the case fatality rate. This study explored the use of low dose aspirin in decreasing the mortality rate of coronavirus disease 2019 associated mucormycosis. METHOD: This was a retrospective observational study. Patients suffering from post-coronavirus disease 2019 mucormycosis were included in the study. Each patient was treated with surgical debridement and systemic amphotericin B. Low dose aspirin was added, and mortality rates were compared with the patients who did not receive aspirin. RESULTS: The demographic data and rhino-orbito-cerebral mucormycosis staging between the two groups were not significantly different. There was a statistically significant difference in mortality outcomes between the two groups (p = 0.029) and a 1.77 times higher risk of dying for patients not receiving aspirin. Kaplan-Meier survival indicated that patients receiving aspirin had better survival rates (p = 0.04). CONCLUSION: Low dose aspirin improves survival rates in coronavirus disease 2019 associated mucormycosis.

Sialic acid blockade in dendritic cells enhances CD8+ T cell responses by facilitating high-avidity interactions.

Sialic acids are negatively charged carbohydrates that cap the glycans of glycoproteins and glycolipids. Sialic acids are involved in various biological processes including cell-cell adhesion and immune recognition. In dendritic cells (DCs), the major antigen-presenting cells of the immune system, sialic acids emerge as important regulators of maturation and interaction with other lymphocytes including T cells. Many aspects of how sialic acids regulate DC functions are not well understood and tools and model systems to address these are limited. Here, we have established cultures of murine bone marrow-derived DCs (BMDCs) that lack sialic acid expression using a sialic acid-blocking mimetic Ac53FaxNeu5Ac. Ac53FaxNeu5Ac treatment potentiated BMDC activation via toll-like receptor (TLR) stimulation without affecting differentiation and viability. Sialic acid blockade further increased the capacity of BMDCs to induce antigen-specific CD8+ T cell proliferation. Transcriptome-wide gene expression analysis revealed that sialic acid mimetic treatment of BMDCs induces differential expression of genes involved in T cell activation, cell-adhesion, and cell-cell interactions. Subsequent cell clustering assays and single cell avidity measurements demonstrated that BMDCs with reduced sialylation form higher avidity interactions with CD8+ T cells. This increased avidity was detectable in the absence of antigens, but was especially pronounced in antigen-dependent interactions. Together, our data show that sialic acid blockade in BMDCs ameliorates maturation and enhances both cognate T cell receptor-MHC-dependent and independent T cell interactions that allow for more robust CD8+ T cell responses.

Rational Hyperoxia in the Perioperative Period: a Safe and Effective Tool in the Reduction of SSI.

Oxygen supplemented at a concentration higher than 40-50 % for at least 2 h perioperatively is expected to reduce surgical site infections (SSI). Although supplementation of 80 % of oxygen perioperatively has shown to reduce SSI in various studies, this concentration is known to be associated with airway complications. This study was taken up to assess the efficacy of 60 %, i.e. <80 and >50 %, inspired oxygen supplemented perioperatively in reducing SSI. One hundred and eighty-eight patients who underwent elective class I and II surgeries were studied. Patients were divided equally into two groups and subgroups and matched for age, sex, type of surgeries, etc. The control group received 30 % and the study group received 60 % oxygen supplementation perioperatively for 2 h. Wounds were observed for the development of SSI. 8/94 patients in the study group and 13/94 patients in the control group developed SSI (p < 0.01). The results indicate a relative risk of 1.62, risk difference of 0.0531 and attributable risk of 38.42 %. Hence, it may be concluded that perioperative oxygen supplementation at 60 % concentration reduces SSI.

Nickel, its adverse health effects & oxidative stress.

Nickel-induced toxicity and carcinogenicity, with an emphasis on the generation and role of reactive oxygen species is reviewed. Nickel is a known haematotoxic, immunotoxic, neurotoxic, genotoxic, reproductive toxic, pulmonary toxic, nephrotoxic , hepatotoxic and carcinogenic agent. This article presents a selective review on nickel and effect of its acute, subchronic and chronic doses on certain metabolically active tissues in human as well as animals. Nickel exposure causes formation of free radicals in various tissues in both human and animals which lead to various modifications to DNA bases, enhanced lipid peroxidation, and altered calcium and sulphydryl homeostasis. The primary route for nickel toxicity is depletion of glutathione and bonding to sulphydryl groups of proteins. Nickel homeostasis, nickel-induced activation of signaling pathways and the protective role of enzymatic and non-enzymatic antioxidants against nickel toxicity and carcinogenicity are also discussed.

Characteristics of patients admitted with stroke.

Population based study on stroke morbidity and mortality is lacking in our country. We described the clinical pattern of patients with stroke admitted in Neuromedicine Unit, Chittagong Medical College Hospital, Bangladesh. One hundred and six consecutive patients were included in the study. Clinical diagnosis of stroke, initial assessment, and assessment of outcome of stroke were performed by the neurologists. On admission blood glucose, and creatinine level was estimated, and an electrocardiogram was recorded. Fasting lipid level estimation and CT-scan of brain were performed for patients who could afford the cost. The mean age of the patients was 60.0 +/-13.7 years and the highest occurrence of stroke was found in the age group of 61 - 70 years. The proportions of rural, semiurban and urban patients were 46.2%, 27.4% and 26.4% respectively. A large portion of the patients were found illiterate (47.2%), and only one patient had postgraduate education. The average per capita income was found 1159 +/-762 taka per month. About one-fourth of the patients had diabetes (21.7%). Hypertension, ischemic heart disease and dyslipidemia were found in 59.4%, 18.9% and 11.3% respectively. The cause of hospitalization was altered consciousness (58.5%), right hemiplegia (32.1%), and left hemiplegia (31.1%) either alone or in combination. The mean duration of hospital stay was 5.25 +/-2.19 days. Fifty percent partially and 35% satisfactorily recovered, and 7 (6.6%) patients expired. Patients from lower socioeconomic group were admitted in the hospital. A considerable number of stroke patients had hypertension and diabetes.

Opportunities not taken: successes and shortcomings in the Institute of Medicine's report on organ donation.

The Institute of Medicine's recent report, Organ Donation: Opportunities for Action, studies the current problems facing organ donation in the USA, making suggestions for quality improvement and analyzing various proposals of incentivized donation and presumed consent (PC). Although the report deals with the donation of several solid organs, this mini review examines the findings from the perspective of kidney transplantation. The committee's recommendations to move from circulatory to neurologic criteria for cadaveric donation and to increase opportunities for donor decision making are prudent. We agree with the committee's arguments against providing incentives for donation because of the inherent distributional inequalities and imperfect information; the intrinsic difficulties in establishing market equilibrium for such heterogeneous and perishable goods; the implied commoditization of the human body; and the inadequate data regarding the long-term risks of living donation. However, we question the committee's firm opposition to PC, especially given recent data from 22 European countries showing a 25-30% increase in organ supply attributable to a PC policy. If this simple change in the default position on donation has the potential to increase organ supply, decrease the need for living donation, reduce the burden on grieving families, maintain familial authority over the deceased, and respect patient autonomy, at least a pilot program of PC seems warranted.

Gastric intestinal metaplasia as detected by a monoclonal antibody is highly associated with gastric adenocarcinoma.

BACKGROUND: Some forms of gastric intestinal metaplasia (GIM) may be precancerous but the cellular phenotype that predisposes to gastric carcinogenesis is not well characterised. Mucin staining, as a means of differentiating GIM, is difficult. A monoclonal antibody, mAb Das-1 (initially called 7E(12)H(12)), whose staining is phenotypically specific to colon epithelium, was used to investigate this issue. METHODS: Using mAb Das-1, by a sensitive immunoperoxidase assay, we examined histologically confirmed GIM specimens from two countries, the USA and Japan. A total of 150 patients comprised three groups: group A, GIM (fields away from the cancer area) from patients with gastric carcinoma (n=60); group B, GIM with chronic gastritis (without gastric carcinoma) (n=72); and group C, chronic gastritis without GIM (n=18). RESULTS: Fifty six of 60 (93%) patients with GIM (both goblet and non-goblet metaplastic cells) from group A reacted intensely with mAb Das-1. Cancer areas from the same 56 patients also reacted. In contrast, 25/72 (35%) samples of GIM from patients in group B reacted with mAb Das-1 (group A v B, p<0.0001). None of the samples from group C reacted with the mAb. CONCLUSIONS: Reactivity of mAb Das-1 is clinically useful to simplify and differentiate the phenotypes of GIM. The colonic phenotype of GIM, as identified by mAb Das-1, is strongly associated with gastric carcinoma.

Pattern of dermatological diseases in Gauhati Medical College and Hospital Guwahati.

A study on 42198 new cases who have attended the Dermatology department of Gawahati Medical College and Hospital, Guwahati, Assam was carried out for a period of 3 years (1998, 1999 and 2000) Eczema (23.10%), pyoderma (14.29%), fungal infection(14.24%) and psoriasis (5.77%) were the major skin diseases in this part of our country. The incidence of S.T.D. and leprosy has been recorded as 2.63% and 2.26% respectively.

Large capillary haemangioma arising from the nasal columella--a case report.

A 39-year-old male presented with a mass arising from the nasal columella for last 8 months. The mass was lobulated, dark red in colour, firm in consistency and approximately 3 cm in diameter. It was attached to the columella of the nose by a narrow stalk. The mass was excised completely under general anaesthesia and histopathological examination suggested it to be a case of capillary haemangioma.

Physical fitness: a longitudinal study among Muslim children of Bijapur (Karnataka).

Aerobic capacity or maximum oxygen uptake capacity (VO2 max) has been widely considered to be reliable and valid measure of cardio respiratory fitness. Persons possessing higher values and have the capacity to yield larger amounts of energy, are capable of performing better in athletic and other field activities. Seventy school going children from the Muslim community of Bijapur (Karnataka) aged 12-16 years (means +/- SEM = 14.33 +/- 0.94), volunteered for this study. Their height (cm) and weight (kg) were measured as physical anthropometry and Body mass index (BMI) was calculated (kg/m2). VO2max (ml.kg-1.min-1) was determined by applying the step test study of Margaria et al. The Physical fitness index (PFI) of the subjects were assessed by Harvard Step Test. The physiological endurance measured as VO2max (ml.kg-1.min-1) was found to be 34.31 +/- 2.44 S.E.M, which is lower in comparison to their Caucasian counterparts but nearly similar when compared with their Indian counterparts. The present study reveals that VO2max significantly correlates with BMI and PFI score. The present study also reveals that 27.2%, 20.07%, 15.77%, 14.37% and 22.87% of the subjects are in excellent, very good, good, average and poor classifications of fitness level respectively.

The influence of ascorbic acid on nickel-induced hepatic lipid peroxidation in rats.

We studied the effect of oral ascorbic acid treatment on nickel sulfate-induced lipid peroxidation in the liver of Wistar strain male albino rats. Lipid peroxide and glutathione levels and the activities of the antioxidant enzymes superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GSH-Px) were estimated in liver. Nickel sulfate administration significantly increased the level of lipid peroxides and decreased glutathione, SOD, CAT, and GSH-Px activities in liver. The simultaneous administration of ascorbic acid with nickel sulfate resulted in a remarkable improvement of lipid peroxide, glutathione, SOD, CAT, and GSH-Px status in liver in comparison with rats treated with nickel alone. Nickel sulfate has an adverse effect on hepatic lipid peroxidation in animals, but simultaneous treatment with ascorbic acid offers a relative protection against nickel-induced hepatotoxicity.

Effect of nickel on testicular nucleic acid concentrations of rats on protein restriction.

The nucleic acids (DNA and RNA) and total protein concentration in testes were estimated in male Wistar strain rats treated intraperitorally with nickel sulfate (2.0 mg/100 g body weight) on alternate days for 10 dosages. In both normal (18% casein) and protein-restricted (5% casein) experimental animals, the nucleic acids and total protein concentration were found to decrease significantly compared to the corresponding controls. Sperm count and sperm motility were also reduced in both experimental groups of animals. The results indicate that nickel influences the expression of genetic information by reducing testicular nucleic acids and protein concentration in both dietary experimental groups.

ROLE OF ASCORBIC ACID ON TRANSAMINASE ACTIVITIES IN SOME METABOLICALLY ACTIVE TISSUES OF ASPIRIN TREATED RATS.

Aspartate amino transferase (GOT) and alanine amino transferase (GPT) activities were studied in plasma, liver and kidney of aspirin treated and ascorbic acid supplemented groups for a period of seven days. GOT and GPT activities were increased in plasma but decreased significantly in liver and kidney in aspirin treated animals. Ascorbic acid supplemented groups showed no significant change of GOT and GPT in plasma and liver. In case of kidney, GOT activity remained unchange but GPT activity showed significant change in ascorbic acid supplemented group. The results clearly indicate that aspirin is a potent hepatotoxic and nephrotoxic drug but supplementation of ascorbic acid in High doses to rats fed aspirin can restore enzyme activities to the normal level.

Efficacy of methotrexate in rheumatoid arthritis.

Rheumatoid arthritis is a common inflammatory articular disorder in Bangladesh. Methotrexate has proved to be an effective and relatively safe disease modifying drug for this disease. A quasiexperimental trial of the efficacy of methotrexate in rheumatoid arthritis was carried out in the Rheumatology Clinic, Institute of Postgraduate Medicine & Research, Dhaka during the period between July 1992 and September 1993. Thirty eight patients fulfilling the revised ARA criteria were given methotrexate in a total weekly dose of 7.5 to 15 mg. They were followed up at weekly intervals for one month and then monthly for a total duration of six months. Twenty three subjects eventually completed the trial. The trial showed significant differences in the disease activity indices at the end of six months. The decline of activity was noted at the end of one month. As a whole the response was complete in 4(17%), marked in 14(61%), moderate in 4(17%) and nil in 1(4%). Adverse effects occurred in 27 subjects. They were mild and transient in 22. Methotrexate appeared to be an acceptable DMARD for our rheumatoid arthritis population.

Influence of ascorbic acid on acid and alkaline phosphatase activities in some metabolically active tissues of aspirin treated rats.

ACP and ALP activities in plasma were increased in aspirin treated groups for a period of seven days. Ascorbic acid supplemented groups showed no significant change in plasma ACP activity, but a significant change in ALP activity was found. ACP and ALP activities in liver and kidney were decreased significantly in aspirin treated animals. ACP activities in liver and kidney in ascorbic acid supplemented groups showed no significant changes. No significant alteration of ALP activity in liver was found in ascorbic acid supplemented group but a significant changes was observed in kidney. Supplementation of ascorbic acid in high doses to rats fed aspirin can restore enzyme activities almost to the normal level.

Alteration of testicular biochemistry during protein restriction in nickel treated rats.

Nickel sulfate (2.0 mg/100 g.b.wt) dissolved in double-distilled water was administered (i.p.) on alternate days for ten doses to normal protein-fed and protein-restricted Wister strain albino rats (b.wt. 160 +/- 5 g). Two groups were used: one with normal protein diet, whereas the other with protein-restricted diet served as control. Twenty-four hours after the last treatment, the animals were sacrificed by decapitation. Tissues such as the testes, seminal vesicles, epididymis (Cauda and Caput) and prostate were dissected out, wiped clean, and stored at -20 degrees C until analysis. Lactate dehydrogenase (LDH) activities, glutamate oxaloacetate transaminase (GOT) activities, glycogen content, cholesterol content, and total protein content of the testes were estimated. Nickel sulfate administration significantly decreased the body weight of both normal protein-fed and protein-restricted groups of animals; the organ weights were also decreased. Significant decrease of LDH activity was observed, but GOT activity was not altered significantly. Testicular glycogen and cholesterol increased significantly in both experimental groups, but total protein content decreased. Nickel sulfate seems to have an adverse effect on the male reproductive system in both groups of animals fed with normal protein (18% casein) diet and protein restricted (5% casein) diet.

Improved heterodyne mixing efficiency and signal-to-noise ratio with an array of hexagonal detectors.

An array of hexagonal pixel geometries is considered and its improvement in the mixing efficiency as well as the signal-to-noise ratio is compared with an equal-area array of square pixel detectors. We also consider the phase-front misalignment between the signal and the local oscillator wave fronts for both pixel geometries.

Efficacy of ciprofloxacin in enteric fever: comparison of treatment duration in sensitive and multidrug-resistant Salmonella.

The efficacy of two regimens of ciprofloxacin was compared in a randomized study conducted on 69 patients with enteric fever, 52.2% of whom had infection with multidrug-resistant (MDR) strains of Salmonella typhi or S. paratyphi. Patients were randomly assigned to two regimens (10 days versus 14 days) of ciprofloxacin (500 mg twice a day). The mean +/- SD time required for defervescence was similar for both regimens (4.2 +/- 1.9 days in the 10-day group and 4.9 +/- 2.6 days in the 14-day group). A 100% cure was observed in each treatment group and no serious side effects were observed. Relapse occurred in two patients (14-day regimen). Only one patient (14-day regimen) had growth of S. typhi in stool culture at the time of the first follow-up three days after completion of therapy. Follow-up studies on available patients on two, six, and 12 months after completion of therapy revealed that all patients had negative stool cultures for S. typhi and S. paratyphi. This study indicates that ciprofloxacin may be recommended as an initial therapy for enteric fever for adult men and nonpregnant and nonlactating women in areas where MDR strains of S. typhi and S. paratyphi are prevalent, and that 500 mg twice a day of the drug given for 10 days is as effective as 14 days at the same dosage.

Place of transvaginal sonography in the evaluation of reproductive endocrinology.

A high frequency vaginal probe with improved resolution offers a remarkable sharp clear image of pelvic organs. This is possible because of its closed proximity with target organ and non-intervention by gut or omentum. Study of ovarian follicular dynamics (folliculometry), identification of proliferative, secretory and decidual changes of endometrium (endometrial dating) in different phases of menstrual cycle and imaging of mucus secretion in the cervical canal (cervical mucus study) in the pre-ovulatory phase is possible by transvaginal probe. It is non-invasive, acceptable to patients, and thus can be repeated any number of times. A close serial monitoring offers immense wealth of information about the anatomical as well as reproductive endocrinal status of the patient. Ovulation can be predicted in advance. The case of dysovulation can be identified in first cycle of study; corrective therapy can be started in another two or three cycles, aiming at achieving perfect folliculogenesis. Once well tuned synchronised cycle is restored, the pregnancy outcome is remarkable. Thus transvaginal sonography offers one of the best reproductive endocrinology evaluation in the hand of a modern gynaecological sonologist and infertility specialist.