Rhino-orbito-cerebral mucormycosis: patient characteristics in pre-COVID-19 and COVID-19 period.

BACKGROUND: Rhino-orbito-cerebral-mucormycosis (ROCM), a rare and potentially fatal disease was seen in increasing numbers during the COVID-19 pandemic. This study describes and compares the patient characteristics and outcomes in COVID-19 associated mucormycosis (CAM) and non-COVID-19 mucormycosis (non-CAM). METHODOLOGY: CAM patients (24 cases) were recruited from the COVID-19 period and non-CAM (24 controls) from the pre-COVID-19 period. Clinical data of the CAM group was collected retrospectively with 3 month outcomes prospectively. The non-CAM group data was collected retrospectively. Patient characteristics were compared and risk factors for mortality in ROCM were assessed. RESULTS: Orbital symptoms [altered vision, restricted eye movements, ptosis] and intracranial involvement were higher in CAM patients on presentation. Similarly, the radiological involvement of orbit (orbital apex, superior orbital fissure) and intracranial cavity (intracranial thrombosis, cavernous sinus) was also higher in CAM patients. Newly detected diabetes was found only in CAM patients (29.2%). Although univariate analysis suggested an increased mortality risk in ROCM patients with orbital involvement, the multivariate analysis showed no increased risk with any of the parameters assessed, including COVID-19 positivity. CONCLUSIONS: Compared to the non-CAM, the disease presentation was severe in CAM with higher frequency of orbital and intracranial involvement. However, with early detection and treatment, the short term survival was comparable in both groups.

Negative pressure wound therapy in elective stoma reversal surgery: results of a UK district general hospital pilot.

The role of negative pressure wound therapy in stoma reversal surgery remains unknown. To evaluate this, a retrospective, non-randomized, single-institution, pilot study was conducted. Surgeon preference determined type of wound closure and application of the single-brand negative wound pressure device. No patient in the intervention group suffered wound complications, but five of the thirty-six patients in the control group suffered surgical site infection-related complications. Primary closure and negative pressure wound therapy use decreases wound complications in stoma reversal surgery, thereby alleviating the wound-management burden in hospitals and in the community. This has cost-saving implications, but further studies are needed.

Biodegradation kinetics of high strength oily pet food wastewater in a membrane-coupled bioreactor (MBR).

Aerobic respirometric experiments were conducted at a temperature of 40 degrees C to determine biokinetic parameters describing growth and decay of aerobic biomass acclimatized in a membrane-coupled bioreactor (MBR). The kinetic parameters were determined with the volatile fatty acids (VFA) acetic acid and propionic acid as substrates as well as the soluble fraction of a high strength rendering wastewater as substrate. The oxygen uptake rate (OUR) and cumulative oxygen uptake (OU) recorded during the experiments were fitted to Monod kinetic model to obtain true yield (Y(t)), intrinsic maximum substrate removal (k), half-saturation constant (K(s)) and endogenous decay coefficient (k(d)). K(s) were determined to be 181, 271 and 806 mg COD l(-1) and k as 1.89, 1.08 and 0.85 mg COD mg VSS(-1)h(-1) for acetate, propionate and rendering wastewater, respectively. The continuous-flow MBR was operated under two HRT conditions, 10 and 5 d, attaining high BOD removal efficiencies of 99% and 87%, respectively. The observed yield in the MBR was 0.03 g VSS g(-1)COD.

Treatment of high-strength pet food wastewater using two-stage membrane bioreactors.

A two-stage membrane bioreactor was used to treat dissolved-air-flotation pretreated, high-strength pet food wastewater characterized by oil and grease concentrations of 50 000 to 82 000 mg/L and total chemical oxygen demand (COD) and five-day biochemical oxygen demand (BOD5) concentrations of 100 000 and 80 000 mg/L, respectively, to meet stringent surface discharge criteria (i.e., BOD5, total suspended solids [TSS], and ammonium-nitrogen [NH4(+)-N] of < 10 mg/L at an overall hydraulic retention time of 6.3 days). Organic contaminants were removed primarily in the first stage, followed by almost complete removal of ammonia in the second stage. Despite a rise in poorly biodegradable COD in the second stage, overall removal of TSS, BOD5, COD, and ammonia was 100, 99.9, 95.2, and 99.7%, respectively, thus readily achieving the required criteria. Consistent nitrite accumulation over a period of more than 100 days, even at dissolved oxygen concentrations of more than 2.5 mg/L, was remarkable. A residual alkalinity requirement for nitrification was quantified. Membrane performance was extensively studied in this work.

Increased oxidative stress in patients with congestive heart failure.

OBJECTIVES: We sought to study the markers of lipid peroxidation and defenses against oxidative stress in patients with varying degrees of heart failure. BACKGROUND: Despite advances in other areas of cardiovascular disease, the morbidity and mortality from congestive heart failure (CHF) are increasing. Data mainly from animal models suggest that free radical injury may promote myocardial decompensation. However, there are no studies in humans correlating the severity of heart failure with increased free radical injury and antioxidants. METHODS: Fifty-eight patients with CHF and 19 control subjects were studied. In addition to complete clinical and echocardiographic evaluations, the prognosis of these patients was established by measuring the levels of soluble tumor necrosis factor-alpha receptors 1 and 2 (sTNF-R1 and sTNF-R2). Oxidative stress was evaluated by measuring plasma lipid peroxides (LPO), malondialdehyde (MDA), glutathione peroxidase (GSHPx) and vitamin E and C levels. RESULTS: The patients' age range, cause of heart failure and drug intake were comparable across the different classes of heart failure. Heart failure resulted in a significant increase in LPO (p < 0.005), MDA (p < 0.005), sTNF-R1 (p < 0.005) and sTNF-R2 (p < 0.005). There was a significant positive correlation between the clinical class of heart failure and LPO, MDA, sTNF-R1 and sTNF-R2 levels. There was an inverse correlation between GSHPx and LPO. With increased lipid peroxidation in patients with CHF, the levels of vitamin C decreased, but vitamin E levels were maintained. CONCLUSIONS: These data demonstrate a progressive increase in free radical injury and encroachment on antioxidant reserves with the evolution of heart failure; they also suggest that oxidative stress may be an important determinant of prognosis. The therapeutic benefit of administering antioxidant supplements to patients with CHF should be evaluated.

Conventional and thermophilic aerobic treatability of high strength oily pet food wastewater using membrane-coupled bioreactors.

Although thermophilic treatment systems have recently gained considerable interest, limited information exists on the comparative performances of membrane-coupled bioreactors (MBR) at thermophilic and conventional conditions. In this study aerobic MBRs operating at room temperature (20 degrees C) and at lower thermophilic range (45 degrees C) were investigated for the treatment of dissolved air flotation (DAF) pretreated pet food wastewater. The particular wastewater is characterized by oil and grease (O & G) concentrations as high as 6 g/L, COD of 51 g/L, BOD of 16 g/L and volatile fatty acid (VFA) of 8.3 g/L. The performances of the two systems in terms of COD, BOD and O & G removal at varying hydraulic retention time (HRT) are compared. COD removal efficiencies in the thermophilic MBR varied from 75% to 98% and remained constant at 94% in the conventional MBR. The O & G removal efficiencies were 66-86% and 98% in the thermophilic and conventional MBR, respectively. Interestingly, high concentrations of VFA were recorded, equivalent to 50-73% of total COD, in the thermophilic MBR effluent. The observed yield in the thermophilic MBR was 40% of that observed in the conventional MBR.

Increased lipid peroxidation after lipid infusion as measured by breath pentane output.

We studied the effect of intravenous lipid infusion on lipid peroxidation as measured by breath pentane. Pentane, plasma alpha-tocopherol (alpha-tox) and plasma gamma-tocopherol (gamma-toc), selenium, and Se-dependent glutathione peroxidase (Se-GSHPx) were measured in 10 normal control subjects and in 10 home parenteral nutrition (HPN) patients before and after infusion of 100 mL Nutralipid 10% over 30 min. Before infusion, breath pentane was significantly higher and alpha-toc was significantly lower in the HPN group than in the control subjects. These two measurements were significantly negatively correlated (r = -0.54, p less than 0.05). Pentane, alpha-toc, and Se-GSHPx were significantly increased in both groups after lipid was infused but were still significantly higher in HPN patients than in control subjects. Thus, infusion of a small amount of lipid rich in linoleic acid induced a significant increase in breath pentane, reflective of increased lipid peroxidation.

Plasma vitamin E and selenium and breath pentane in home parenteral nutrition patients.

Because both vitamin E and selenium protect against lipid peroxidation, we evaluated the relationship between breath pentane, evolved from the peroxidation of linoleic acid, and plasma levels of alpha-tocopherol (vitamin E), Se, and Se-dependent glutathione peroxidase (Se-GSHPx). Nine home parenteral-nutrition (HPN) patients received added Se in intravenous solutions and were compared with 10 normal control subjects. The excretion of pentane (pmol.kg-1.min-1, means +/- SEM) in control subjects (6.34 +/- 0.96) was significantly lower than in HPN patients (15.02 +/- 1.12, p less than 0.001). alpha-Tocopherol (mumol/L), Se (mumol/L), and Se-GSHPx (U) values were, respectively, 18.13 +/- 1.70, 1.70 +/- 0.05, and 5.34 +/- 0.27 in control subjects and 10.21 +/- 1.66, 1.35 +/- 0.14, and 7.01 +/- 0.31 in HPN patients. All differences were statistically significant. Significant negative correlations were observed between plasma alpha-tocopherol levels and HPN duration and between pentane output and plasma alpha-tocopherol levels (r = -0.58, p less than 0.01). In HPN patients with reduced plasma alpha-tocopherol levels associated with increased pentane output, there is, inferentially, increased lipid peroxidation despite normal plasma Se and Se-GSHPx levels.

Vitamin E and selenium status of patients receiving short-term total parenteral nutrition.

In a prospective protocol, plasma tocopherols, selenium (Se), Se-dependent glutathione peroxidase, platelet aggregation and erythrocyte hemolysis were measured in 23 control subjects, and 15 patients receiving total parenteral nutrition (TPN), before and after 2 wk of TPN unsupplemented with vitamin E and Se. The results indicate that short-term TPN did not alter status of these nutrients. However, TPN patients had significantly lower plasma levels of Se (p less than 0.01) and alpha-tocopherol (p less than 0.01) relative to control subjects. Low plasma levels, with no attendant decrease in function, suggest a marginal depletion. In view of this, and considering the low amount of vitamin E and Se supplied by the TPN solutions, supplementation with these nutrients is recommended.

Breath pentane analysis as an index of lipid peroxidation: a functional test of vitamin E status.

Pentane, which evolves from the reaction involving omega-6 fatty acids, is a good index of lipid peroxidation. We describe a method for measuring breath pentane excretion in adult humans. After a 4-minute washout period, expired air was analyzed by gas chromatography. Breath was passed through a cooled loop of alumina to adsorb, concentrate, and release, on heating, pentane. Pentane was analyzed by a Porasil-D column with a derived calibration curve. The mean excretion of pentane in 10 normal adults was 6.34 +/- 0.96 pmol X kg-1 X min-1 (mean +/- SEM) and was significantly higher in five patients with plasma vitamin E deficiency (15.39 +/- 1.84 pmol X kg-1 X min-1). There was a significant negative correlation between pentane output and plasma vitamin E levels (r = -0.66, p less than 0.01). Moreover, breath pentane excretion was significantly decreased after a 10-d supplementation with vitamin E in five normal subjects. We conclude that breath pentane output is a sensitive, noninvasive, functional test for assessing vitamin E status.

Effects of beta-carotene supplementation on lipid peroxidation in humans.

The ability of beta-carotene (BC) to reduce lipid peroxidation in humans was investigated. In this randomized double-blind controlled trial, 42 nonsmokers and 28 smokers received either 20 mg BC or placebo daily for 4 wk. Twenty-five smokers and 38 nonsmokers completed the trial. Changes in plasma BC concentrations increased significantly (P < 0.0005) and to the same extent in both groups supplemented with BC. There were no significant changes among the placebo groups. At baseline, lipid peroxidation measured by breath-pentane output (BPO) was significantly higher in the two smoking groups (BC: 8.8 +/- 1.1, placebo: 9.4 +/- 1.4 pmol.kg-1.min-1) than in the two nonsmoking groups (BC: 5.7 +/- 0.5, placebo: 5.9 +/- 0.6 pmol.kg-1.min-1) (P < 0.005). BPO decreased significantly only in smokers receiving BC (6.5 +/- 0.7 pmol.kg-1.min-1) (P < 0.04). Changes in breath-ethane output were not significant. Therefore, lipid peroxidation measured by BPO is significantly higher in smokers than in nonsmokers and is reduced by BC supplementation in smokers. There was no significant change (95% CI - 1.26, 1.12) in BPO when nonsmokers received BC.

A controlled clinical trial of vitamin E supplementation in patients with congestive heart failure.

BACKGROUND: Oxidative stress is increased in patients with congestive heart failure and can contribute to the progressive deterioration observed in these patients. Increased oxidative stress is the result of either an increased production of free radicals or a depletion of endogenous antioxidants, such as vitamin E. OBJECTIVE: We aimed to determine whether vitamin E supplementation of patients with advanced heart failure would modify levels of oxidative stress, thereby preventing or delaying the deterioration associated with free radical injury. DESIGN: Fifty-six outpatients with advanced heart failure (New York Heart Association functional class III or IV) were enrolled in a double-blind randomized controlled trial for 12 wk. At a baseline visit and at 2 follow-up visits, blood and breath samples were collected for the measurement of indexes of heart function and disease state, including malondialdehyde, isoprostanes, and breath pentane and ethane. Quality of life was also assessed at baseline and after 12 wk of treatment. RESULTS: Vitamin E treatment significantly increased plasma concentrations of alpha-tocopherol in the treatment group but failed to significantly affect any other marker of oxidative stress or quality of life. In addition, concentrations of atrial natriuretic peptide (a humoral marker of ventricular dysfunction), neurohormonal-cytokine markers of prognosis, tumor necrosis factor, epinephrine, and norepinephrine were unchanged with treatment and were not significantly different from those in the control group. CONCLUSION: Supplementation with vitamin E did not result in any significant improvements in prognostic or functional indexes of heart failure or in the quality of life of patients with advanced heart failure.

Tip-link integrity on chick tall hair cell stereocilia following intense sound exposure.

Hair bundle tip links have been implicated in the process of hair cell transduction, and previous studies have shown that acoustic overstimulation or exposure to low calcium can disrupt them. Severed tip links would thus be expected to cause a loss in hair cell function. This study investigates the presence of tip links on chick tall hair cells at three exposure durations and three recovery durations. After 4, 24, or 48 h of exposure, and 24, 96, and 288 h of recovery, the basilar papilla was harvested and prepared for scanning electron microscopy. Photomicrographs of hair bundles from sound-exposed and age-matched control ears were obtained in regions of the papilla adjacent to the 'patch' lesion. The percentage of tip links present on these hair bundles was determined from the photomicrographs. After 4, 24, or 48 h of exposure, an average of 49%, 41.1% and 52% of the observed sensory hairs exhibited links. This was significantly lower than that seen in the control ears (71.2%). There also was a reliable recovery of tip links between 24 and 48 h of exposure. The recovery continued and by 24 h post exposure, tip links were present on 61.3% of the sensory hairs. At subsequent recovery intervals, the mean number of tip links on sound-exposed tall hair cells was statistically the same as seen on control cells. The results indicated a predictable loss in the number of tip links during the exposure and their restoration within a relatively short time after the exposure. This structural damage to the tall hair cell, and its recovery, could account for some of the loss and recovery of function in the auditory periphery of these sound-damaged chicks.

Maturation of tympanic membrane layers and collagen in the embryonic and post-hatch chick (Gallus domesticus).

The surface area of the chick (Gallus domesticus) tympanic membrane (TM) increases by as much as 400% from hatching to 70 days of age (Cohen et al. [1992] J. Morphol. 212:187-193). The present study is concerned with the processes that contribute to this remarkable size increase. Middle-ear specimens were harvested in embryos aged between E10 and E18, and in post-hatch animals between days P1 and P57. Specimens were embedded in paraffin, cut in serial sections, stained for collagen fibers, and examined with light microscopy. Four locations were examined in each specimen: the anterior and posterior perimeter of the TM, the TM, over the extra-stapedius, and the TM at the tip of the extra-columella. The thickness of the epithelial, respiratory, and lamina propria layers was measured at each location. The radial collagen fibers in the lamina propria were also counted at each location, and fiber density per square micrometer was determined at each age. Thickness of the epithelial and respiratory layers remains relatively constant throughout development in all areas of the TM, whereas the lamina propria at the extra-columella and extra-stapedius continues to thicken with increasing age. Collagen density also increases during development, and this is attributed to an increase in fiber number and a reduction in the space between fibers. The results suggest that collagen may be synthesized first in the central regions of the TM and then later in more peripheral areas of the TM.

Vitamin E suppresses increased lipid peroxidation in cigarette smokers.

Cigarette smoke contains many xenobiotics, including oxidants and free radicals, which can increase lipid peroxidation. Recently, breath pentane output (BPO) has been recognized as a good indicator of lipid peroxidation. Vitamin E is known to be a potent free radical scavenger which can protect biological membranes against oxidative damage. We investigated the effect of vitamin E (dl-alpha-tocopherol) on lipid peroxidation in 13 healthy smokers. The results showed (1) smokers had increased BPO as compared with 19 healthy non-smokers (16.3 +/- 1.9 vs 5.8 +/- 0.5, pmol/kg body weight/min, p less than 0.001) although both groups had comparable plasma vitamin E and selenium concentrations, (2) supplementation with vitamin E (800 mg/day for 2 weeks) decreased BPO in smokers, and (3) the concentration of plasma selenium-dependent glutathione peroxidase was restored to normal in those smokers (five out of 13) in whom this was low initially. We conclude that a normal plasma concentration of vitamin E does not prevent this increase of lipid peroxidation in smokers but that substantial doses of vitamin E will significantly reduce this increased lipid peroxidation. If a major function of vitamin E is to protect lipids from peroxidation, then smokers have a conditioned insufficiency of vitamin E on a normal diet.

Conditioned nutritional deficiencies in the cardiomyopathic hamster heart.

BACKGROUND: Evidence indicates that nutritional factors may be important in the maintenance of myocyte structure and energetics. The failing myocardium has been reported to exhibit a depletion of several nutrients that are important for the maintenance of intracellular calcium homeostasis and cellular energetics, and levels of oxidative stress. This nutrient depletion may contribute to the progressive deterioration in myocardial structure and function observed in heart failure. OBJECTIVE: To examine the extent to which advanced cardiomyopathy results in a depletion of nutrients and/or metabolites and antioxidants, and whether supplementation with these nutrients may influence cellular structure or function. SUBJECTS AND METHODS: Cardiomyopathic hamsters were randomly placed to one of the three following diet groups: chow; control gelled diet; or a supplemented gelled diet that provided taurine, carnitine, coenzyme Q10, selenium, vitamins E and C, creatine, thiamine and L-cysteine. After approximately three months of supplementation, one group of hamsters underwent functional testing using a modified Langendorff technique with biopsy samples taken for electron microscopy. Myocardial nutrient concentrations were determined in a second group of diseased and nondiseased hamsters of the same age. RESULTS: Cardiomyopathy resulted in a depletion of vitamin E, creatine, carnitine, taurine and coenzyme Q10. Supplementation resulted in improved cardiac ultrastructure, function and contractility compared with nonsupplemented hamsters. CONCLUSIONS: These studies suggest that heart failure results in 'condition-related nutrient deficiencies' that, once corrected, can significantly impact on heart function and structure.

Lipid peroxidation during n-3 fatty acid and vitamin E supplementation in humans.

The purpose of this study was to investigate in healthy humans the effect of eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) intake, alone or in combination with dL-alpha-tocopherol acetate (vitamin E) supplements on lipid peroxidation. Eighty men were randomly assigned in a double-blind fashion to take daily for 6 wk either menhaden oil (6.26 g, n-3 fatty acids) or olive oil supplements with either vitamin E (900 IU) or its placebo. Antioxidant vitamins, phospholipid composition, malondialdehyde (MDA), and lipid peroxides were measured in the plasma at baseline and week 6. At the same time, breath alkane output was measured. Plasma alpha-tocopherol concentration increased in those receiving vitamin E (P < 0.0001). In those supplemented with n-3 fatty acids, EPA and DHA increased in plasma phospholipids (P < 0.0001) and plasma MDA and lipid peroxides increased (P < 0.001 and P < 0.05, respectively). Breath alkane output did not change significantly and vitamin E intake did not prevent the increase in lipid peroxidation during menhaden oil supplementation. The results demonstrate that supplementing the diet with n-3 fatty acids resulted in an increase in lipid peroxidation, as measured by plasma MDA release and lipid peroxide products, which was not suppressed by vitamin E supplementation.

Antibacterial activity of ciprofloxacin-beta-cyclodextrin complex and its efficacy in dental implants.

Ciprofloxacin forms an inclusion complex with beta-cyclodextrin. The in vitro antibacterial activity of ciprofloxacin on E. coli and Staphylococcus aureus was found better on complexation. The complex was found very effective as a local antibacterial agent when used in dental implants. Significant reduction in the gingival index, probing pocket depth and microbial growth coupled with gain in attachment at the test site compared to control on the 14th day was observed when the implants containing 2.0 mg of the complex equivalent to 0.4 mg of ciprofloxacin was used in clinical trials.

Chromosomal Aberrations and Exon 1 Mutation in the AKR1B1 Gene in Patients with Diabetic Neuropathy.

BACKGROUND: Recent decades have seen an increase in our understanding of a number of pathophysiological processes associated with type 2 diabetes mellitus (DM). Despite increases in understanding and treatment options, diabetic neuropathy remains a significant problem and is associated with tremendous morbidity and mortality. In this regard, oxidative DNA damage is postulated to play a role in diabetes-mediated neuropathic pathogenesis. METHODS: In this pilot investigation, we studied the extent of chromosomal damage utilizing chromosomal aberration (CA) assay in cultured lymphocytes of patients in 3 subgroups: patients with diabetic neuropathy, patients with type 2 DM and no neuropathy, and a control group. RESULTS: The patients with diabetic neuropathy showed a statistically significantly higher rate of CA (P<0.001, 0.086 ± 0.04) compared to the DM patients without neuropathy (0.03 ± 0.02). Samples from subjects with diabetic neuropathy were evaluated to check for mutations in the AKR1B1 gene (exon 1). A significant number of mutations appeared after DNA sequencing within the AKR1B1 gene. Of 50 diabetic neuropathy patient samples analyzed, 10 revealed mutations. CONCLUSION: Our results suggest that painful diabetic neuropathy is a condition with enhanced genomic instability characterized by increased CA and possible mutations. Exon 1 of the gene AKR1B1 showed significant mutations in patients with painful diabetic neuropathy.