Glycemic Control and Mucormycosis during COVID-19 Pandemic in India a Study of Stage and Outcome.

INTRODUCTION: Mucormycosis mostly targets immunocompromised patients or those with uncontrolled diabetes but is now an important complication after coronavirus disease 2019 (COVID-19) infection. The stage of mucormycosis at presentation greatly impacts its treatment course and prognosis. Prior research has failed to evaluate an association of patient factors, especially glycated hemoglobin (HbA1c) levels and random blood sugar (RBS) at presentation, with the stage and outcome of mucormycosis. OBJECTIVES: To investigate the relationship between glycemic control and the stage of mucormycosis at presentation and to investigate various factors affecting mucormycosis outcome. MATERIALS AND METHODS: All patients with clinicopathologically confirmed mucormycosis presenting to Safdarjung Hospital, New Delhi, during the COVID-19 pandemic were enrolled in the study. A questionnaire consisting of demographic information, comorbidities, history, and treatment of COVID-19 and diabetes was filled out at the time of admission. Blood glucose and HbA1c levels at presentation were noted. The above-noted parameters were compared with the stage and outcome of mucormycosis. The data obtained was analyzed. RESULTS: A total of 75 mucormycosis patients were enrolled in the study. The mean age of the participants was 45.17 years, and 85.33% of them survived the disease course. There was no statistically significant difference between the survivors and nonsurvivors concerning mean HbA1c and RBS levels. But there was a statistically significant correlation such that the stage of mucormycosis increased with progressive worsening glycemic control markers HbA1c and RBS. The most common comorbid condition was diabetes mellitus (72%); however, only coronary artery disease in the patient was significantly correlated with mortality. A history of COVID-19 infection was reported in 67.6% of the patients, but this was not significantly associated with mortality outcomes. Patients without a history of COVID-19 reported significantly higher RBS and HbA1c levels at presentation than the COVID-19-associated mucormycosis group. CONCLUSION: The study showed a positive correlation between the stage of mucormycosis and serum glycemic control markers at presentation. Clinicians must order blood sugar and HbA1c levels at presentation as cues for a better understanding of disease severity. A thorough clinical examination and history taking for patient risk factors predisposing to mucormycosis are also crucial since the presence of proptosis and coronary artery disease are significantly correlated with the mortality outcomes. The extent of poor glycemic control at presentation was not associated with mortality outcomes. How to cite this article: Sharma V, Kriplani K, Tuli IP, et al. Glycemic Control and Mucormycosis during COVID-19 Pandemic in India a Study of Stage and Outcome. J Assoc Physicians India 2023;71(9):61-66.

Antibiogram guided optimized medical treatment in chronic otitis media: A useful interventional strategy before surgery?

BACKGROUND: Chronic otitis media is a middle ear cleft disease presenting with tympanic membrane perforation and discharge. Wet ear after tympanoplasty and discharging mastoid cavity are problematic in clinical practice. MATERIAL AND METHODS: 1050 patients of age 10 to 50 years presenting with active ear discharge and clinically diagnosed with unilateral chronic suppurative otitis media were included in the study. The patients were equally divided into two equal groups, Group ET, and AT. All patients were prescribed topical ciprofloxacin, oral levocetirizine 5 mg and n-acetyl cysteine 600 mg BD for one week. Swabs of ear discharge were collected in ET groups for antibiogram. Both groups were evaluated on next visit and treatment changed in AT groups and result observed in next visit. Surgical outcome was evaluated at end of 2 yrs. RESULT: A total of 1158 organisms were isolated in culture out of which, 69.94 % were aerobes, 13.47 % anaerobes and 16.58 % were fungi. On the second visit in group AT, treatment of 85.14 % patients was changed in accordance with culture sensitivity report. In patients with mucosal disease, only 46.87 % patients of group ET had a favorable outcome in comparison to 90.28 % patients of group AT while in patients with squamosal disease, 17.56 % patients of group ET and 28.99 % patients in group AT had a dry ear. Surgeries in AT group were found to have statistically significant higher success rate as compared to ET group.

Olfactory and Gustatory Dysfunctions in Patients With Laboratory-Confirmed COVID-19 Infection: A Change in the Trend.

To study the presence of olfactory and gustatory dysfunctions in patients with laboratory-confirmed COVID-19 infection in our set up. Longitudinal study, 1st March 2020-15th August 2020, at a tertiary care hospital. RT PCR positive for SARSCoV-2 patients, above 18 years age included. Excluding patients with previous history of changes in smell or taste sensation, severely ill at the time of admission, history of taking drugs at the time of COVID 19 infection that affect the smell or taste sensation. 435 patients included after obtaining an institutional ethical clearance. After an informed consent, these patients were followed up telephonically, to record any subjective improvement in olfactory or gustatory symptoms and an approximate duration of recovery. Olfactory and/or gustatory dysfunction 10.8% (47/435). Mean (SD) age-34.53(10.8) years. Females affected significantly more [X2 (1, N = 435) = 7.45, p value is 0.006, significant at p < 0.05]. Olfactory dysfunction significantly associated with gustatory dysfunction [X2 (1, n = 435) = 182.29, p < 0.00001]. 19.8% (N = 435) of individuals remained asymptomatic. Nasal symptoms rare (4%, N = 47). Mean (SD) recovery olfactory and gustatory dysfunction 12.1 (7.7) and10.8 (6.3) days respectively. Subjective loss of smell or taste dysfunction was far less common. Women and younger population reported olfactory or gustatory dysfunction commonly. Olfactory and gustatory changes without nasal symptoms, suspicion of COVID-19 infection is relevant. Recovery is complete and early.

Diagnostic and therapeutic endonasal rhinologic procedures generating aerosol during COVID-19 pandemic: a systematized review.

INTRODUCTION: Most rhinologic procedures, particularly endoscopic sinonasal procedures, are liable to produce aerosols. The severe acute respiratory syndrome coronavirus 2 (SARS-Co V-2) transmits via respiratory droplets, but the degree of its spread through airborne routes by aerosol is unclear. OBJECTIVE: The aim of this article is to counsel rhinologists on how to modify their conventional practice during the COVID-19 pandemic by prioritising the need of procedures, identifying aerosol- generating procedures and using precise personal protection equipment for various endonasal procedures. METHODS: We did a review of articles indexed for MEDLINE on PubMed, ENT Cochrane, DOAJ and Web of Science databases using the keywords nasal endoscopy, SARS-CoV-2, COVID-19, aerosol generating medical procedures and rhinology to formulate guidelines for the safety of healthcare workers. RESULTS: The review included evidence from 28 articles from the otorhinolaryngology, surgery, infectious disease, head and neck surgery and cancer biology literature. We have provided recommendations and relevant information for rhinologists during the COVID-19 pandemic, based on the available studies and data, to warrant high-quality patient care and requisite levels of infection prevention during rhinology procedures. CONCLUSION: In rhinology, marked care is advised during nasal packing, electrocauterisation and use of high-speed rotating devices in potentially infected tissue as they are considerable aerosol- producing procedures. The choice of personal protective equipment is based on the risk of exposure and possible modes of aerosol generation.

ENT manifestations of tuberculosis: an important aspect of ENT practice.

Tuberculosis involving organs other than the lungs is termed as 'extra pulmonary tuberculosis'. Tuberculosis (TB) remains a worldwide public health problem despite the fact that the causative organism was discovered more than 100 years ago. The present study was conducted to assess different manifestations of tuberculosis affecting the ear, nose and throat (ENT) in patients attending the outpatient department in a total of 520 cases of tuberculosis. One hundred and eight cases were of extra pulmonary tuberculosis. Sixty nine cases had the manifestations of TB in the ENT region. These included patients with tuberculous cervical lymphadenopathy (91.35), laryngeal TB (4.3%), tuberculous otitis media (1.4%), nasal TB (1.4%) and oral tuberculosis (1.4%). Extra pulmonary tuberculosis constitutes about 15-20% of all tuberculosis cases as per WHO survey and it is 20.6% in the present study.

Modification of low temperature magnetic interactions in Dy1-x Eu x MnO3.

Solid solutions of rare earth ion (Eu3+) substituted DyMnO3, Dy1-x Eu x MnO3 (x = 0.0-1.0) have been synthesized by ceramic method. Powder X-ray diffraction revealed single phase nature of the compounds with orthorhombic structure. Contributions from the atomic vibrations to the observation of Raman bands have been established and assigned to symmetry stretching and anti symmetry stretching, bending and tilting modes. Raman band frequencies of tilting, asymmetric stretching and bending modes were found to decrease with increasing europium concentration showing softening. Transport studies revealed that all the compounds show semiconducting nature. While the end compounds display hopping process for electrical conduction, all the substituted compounds showed activated type of conduction, and activated energy was found to reduce with increase in x. Molar susceptibility of the substituted compounds for x = 0.1, 0.3 and 0.5 revealed an antiferromagnetic transition corresponding to Mn ions. The fitted Curie-Weiss temperatures also suggested the existence of antiferromagnetic interactions in all the materials. The magnetic field dependent magnetization at various temperatures revealed paramagnetic nature down to 8 K below which hysteresis loops are observed. The presence of strong ferromagnetic correlations between Dy and Mn spins through apical oxygen ions results in the large coercive fields. For temperatures above the antiferromagnetic temperature of manganese ions (39 K) M-H curves show almost straight lines implying the absence of ferromagnetic interactions in the compounds. Different magnetic transitions: from high temperature paramagnetic state to intermediate temperature antiferromagnetic state to low temperature ferromagnetic states are observed in the M-H data.

Quantum coherence phenomenon in disordered Bi2SeTe2 topological single crystal: effect of annealing.

We report a comparative magnetotransport study on pristine and annealed Bi2SeTe2 single crystals. The pristine sample shows a metallic trend from 300 to 180 K, and an insulating behavior for T < 180 K, whereas the annealed sample exhibits an insulating nature in the entire 4.2-300 K temperature range. Magnetoresistance (MR) of pristine and annealed samples reveals contrasting behaviour as a function of temperature (T) and magnetic field (B). At 4.2 K, the pristine sample shows weak antilocalization (WAL) behavior at low fields and transforms to weak localization (WL) behavior (negative MR) for B > 2.5 T. Further, the quantum MR behaviours seen at low temperature gradually transform to classical B 2 dependent upon increasing the temperatures. In contrast, the annealed sample shows a WAL at small field superimposed on a parabolic feature for B > ±4 T at low temperatures (T < 20 K). It shows a linear MR at intermediate temperatures (40 K < T < 100 K) and a parabolic MR at temperatures T > 100 K. Hall measurements on both samples exhibit a nonlinear behavior at 4.2 K pointing to the existence of two types of carriers with different mobility. The annealed sample also shows a drastic decrease in mobility by one order of magnitude and a reduction in Ioffe-Regel parameter (k F l) by a factor of ~3. Disorder-induced localization of bulk carriers and its coexistence with localization-immune surface carriers at low T leads to WAL and WL. MR observed in the annealed sample can be attributed to the presence of both quantum-classical contribution and has been analysed using the Hikami-Larkin-Nagaoka (HLN) equation.

Magneto-transport behaviour of Bi2Se3-xTex : role of disorder.

Magneto-resistance and Hall resistance measurements have been carried out in fast-cooled single crystals of Bi2Se3-xTex (x = 0 to 2) in 4-300 K temperature range, under magnetic fields up to 15 T. The variation of resistivity with temperature that points to a metallic behaviour in Bi2Se3, shows an up-turn at low temperatures in the Te doped samples. Magneto-resistance measurements in Bi2Se3 show clear signatures of Shubnikov-de Hass (SdH) oscillations that gets suppressed in the Te doped samples. In the Bi2SeTe2 sample, the magneto-resistance shows a cusp like positive magneto-resistance at low magnetic fields and low temperatures, a feature associated with weak anti-localisation (WAL), that crosses over to negative magneto-resistance at higher fields. The qualitatively different magneto-transport behaviour seen in Bi2SeTe2 as compared to Bi2Se3 is rationalised in terms of the disorder, through an estimate of the carrier density, carrier mobility and an analysis in terms of the Ioffe-Regel criterion with support from Hall Effect measurements. We demonstrate that by introducing Te, in the strongly disordered samples a smooth crossover of SdH and WAL can be seen in the Bi2Se3-xTex series, both of which provide signatures for the presence of topological surface states.

Diagnostic and therapeutic endonasal rhinologic procedures generating aerosol during COVID-19 pandemic: a systematized review / Procedimentos endonasais de rinologia diagnósticos e terapêuticos geradores de aerossóis durante a pandemia de Covid-19: uma revisão sistematizada,

Abstract Introduction Most rhinologic procedures, particularly endoscopic sinonasal procedures, are liable to produce aerosols. The severe acute respiratory syndrome coronavirus 2 (SARS-Co V-2) transmits via respiratory droplets, but the degree of its spread through airborne routes by aerosol is unclear. Objective The aim of this article is to counsel rhinologists on how to modify their conventional practice during the COVID-19 pandemic by prioritising the need of procedures, identifying aerosol- generating procedures and using precise personal protection equipment for various endonasal procedures. Methods We did a review of articles indexed for MEDLINE on PubMed, ENT Cochrane, DOAJ and Web of Science databases using the keywords nasal endoscopy, SARS-CoV-2, COVID-19, aerosol generating medical procedures and rhinology to formulate guidelines for the safety of healthcare workers. Results The review included evidence from 28 articles from the otorhinolaryngology, surgery, infectious disease, head and neck surgery and cancer biology literature. We have provided recommendations and relevant information for rhinologists during the COVID-19 pandemic, based on the available studies and data, to warrant high-quality patient care and requisite levels of infection prevention during rhinology procedures. Conclusion In rhinology, marked care is advised during nasal packing, electrocauterisation and use of high-speed rotating devices in potentially infected tissue as they are considerable aerosol- producing procedures. The choice of personal protective equipment is based on the risk of exposure and possible modes of aerosol generation.

Resumo Introdução A maioria dos procedimentos rinológicos, principalmente os procedimentos endoscópicos nasossinusais, é suscetível à produção de aerossóis. A síndrome respiratória aguda grave coronavírus-2 (SARS-CoV-2) é transmitida através de gotículas respiratórias, mas o grau de sua disseminação através de aerossóis por via aérea não é claro. Objetivos Orientar os rinologistas sobre como modificar sua prática convencional durante a pandemia de Covid-19, priorizar a necessidade de procedimentos, identificar procedimentos geradores de aerossol e usar equipamento de proteção individual de precisão para vários procedimentos endonasais. Método Fizemos uma revisão de artigos indexados na Medline por meio das bases de dados PubMed, ENT Cochrane, DOAJ e Web of Science, com as palavras-chave nasal endoscopy, SARS-CoV-2, Covid-19, aerosol-generating medical procedures e rhinology para formular diretrizes para a segurança dos profissionais de saúde. Resultados A revisão incluiu evidências de 28 artigos de otorrinolaringologia, cirurgia, doenças infecciosas, cirurgia de cabeça e pescoço e biologia do câncer. Fornecemos recomendações e informações relevantes para rinologistas durante a pandemia de Covid-19, com base nos estudos e dados disponíveis, para garantir atendimento de alta qualidade ao paciente e níveis necessários de prevenção da infecção durante procedimentos de rinologia. Conclusões Em rinologia, recomenda-se cuidado acentuado durante o tamponamento nasal, eletrocauterização e uso de dispositivos rotativos de alta velocidade em tecidos potencialmente infectados, pois esses procedimentos são consideráveis produtores de aerossóis. A escolha do equipamento de proteção individual é baseada no risco de exposição e nos possíveis modos de geração de aerossol.

Structural investigations in BaFe(2-x)Ru(x)As2 as a function of Ru and temperature.

We present the results of synchrotron X-ray diffraction (XRD) measurements on powdered single-crystal samples of BaFe(2-x)Ru(x)As2, as a function of Ru content, and as a function of temperature, across the spin-density wave transition in BaFe(1.9)Ru(0.1)As2. The Rietveld refinements reveal that with Ru substitution, while the a-axis increases, the c-axis decreases. In addition, the variation of positional coordinates of As (z(As)), the Fe-As bond length and the As-Fe-As bond angles have also been determined. In the sample with x = 0.1, temperature-dependent XRD measurements indicate that the orthorhombicity shows the characteristic increase with a decrease in temperature, below the magnetic transition. It is seen that the c-axis, the As-Fe-As bond angles, Fe-As bond length and positional coordinates of the As show definite anomalies close to the structural transition. The observed anomalies in structural parameters are analysed in conjunction with restricted geometric optimization of the structure using ab initio electronic structure calculations.

57Fe Mössbauer studies across the spin density wave transition in BaFe2-xRuxAs2.

Mössbauer measurements have been carried out in powdered single crystalline samples of BaFe(2-x)RuxAs(2), for Ru concentration in the x = 0.0-0.5 range. The internal hyperfine field (B(hf)) measured at 5 K is found to decrease with an increase in Ru concentration, consistent with the disappearance of a magnetic ground state with Ru substitution. The temperature dependent Mössbauer measurements have been used to study the evolution of magnetic ordering at the Fe sites, in samples with a Ru fraction of x = 0.1 and 0.5. From the analysis of the data, it is surmised that the isomer shift increases with a decrease in temperature, with a characteristic slope change at the structural transition in both samples studied. In both the x = 0.1 and x = 0.5 samples, a low B(hf) centred around 0.5 Tesla is seen to occur well above the structural transition temperature, the contribution from which is suppressed with a decrease in temperature. Below the structural transition temperature, a bimodal distribution of B(hf) centred at about 3 Tesla and 5 Tesla emerges, the contribution from which increases with a further decrease in temperature. Spin polarized density functional calculations suggest the occurrence of different magnetic moments at the Fe sites in the Ru substituted compounds, and provide a rationale for the experimentally observed multimodel B(hf).

High pressure studies on RuIn3 single crystal.

Temperature- and pressure-dependent electrical resistivity studies have been carried out on RuIn(3) single crystal in the 4-300 K range at various pressures between 0 and 5 GPa. While intrinsic semiconducting behaviour is inferred at higher temperatures above 275 K, the low temperature resistivity is primarily dictated by impurity effects. An insulator to metal transition is observed in the low temperature regime around ∼ 1.2 GPa pressure. Band structure calculations show a monotonic decrease of energy gap from a value of 0.222 eV at 0 GPa to 0.167 eV at 8 GPa with increasing pressure, consistent with the experimental findings.

(75)As NMR study of antiferromagnetic fluctuations in Ba(Fe(1-x)Ru(x))(2)As(2).

The evolution of (75)As NMR parameters with composition and temperature was probed in the Ba(Fe(1-x)Ru(x))(2)As(2) system where Fe is replaced by isovalent Ru. While the Ru end member was found to be a conventional Fermi liquid, the composition (x = 0.5) corresponding to the highest T(c) (20 K) in this system shows an upturn in the (75)As [Formula: see text] below about 80 K, evidencing the presence of antiferromagnetic (AFM) fluctuations. These results are similar to those obtained in another system with isovalent substitution, BaFe(2)(As(1-x)P(x))(2) (Nakai et al 2010 Phys. Rev. Lett. 105 107003) and point to a possible role of AFM fluctuations in driving superconductivity.