Fetomaternal outcome in pregnancy with cardiac disease-a case series

Cardiac disease is an important cause of maternal mortality and morbidity in ante partum and postpartum period. Incidence of heart disease in pregnancy is <1%. Pre pregnancy diagnosis, counselling, antenatal supervision, delivery at equipped centre and management with multidisciplinary approach favours the maternal and fetal outcome. This consists of case series of 16 patients with cardiac disease admitted in the department of obstetrics and gynecology at Gulbarga institute of medical sciences, Kalaburgi from January 2022 to June 2023.

Trouble doubled: a rare case of Schaaf Yang syndrome with severe acute malnutrition

Schaaf-Yang syndrome is a genetic disorder caused by mutations in the paternal allele of the Melanoma antigen L2 (MAGEL2) gene. Developmental delay, feeding difficulties with joint contractures and a high prevalence of development disorders including autism are characteristic of this syndrome. We describe a unique case of an infant with Schaaf-Yang syndrome who presented with failure to thrive. The case emphasizes the need for genome sequencing for early diagnosis and management of this rare genetic disease. It also highlights the need to think beyond nutrition when it comes to severe acute malnutrition.

Correlation of lipid profile of infertile men with abnormal semen parameters

Background: Male’s inability to impregnate a fertile female is referred as male factor infertility. It accounts for 40-50% of infertile couples and affects almost 7% of all men. Male comorbidities and conditions, which negatively affect men’s health, have been repeatedly associated with impaired reproductive functioning. Cholesterol is the main substrate for steroid synthesis and it plays crucial role in formation of sperm plasma membrane and thus in spermatogenesis, highlighting the role of serum lipids in male fecundity. Purpose of the study is to evaluate correlation lipid profile of male partners with abnormal semen parameters in infertile couples.Methods: A cross sectional study was carried out in the infertility clinic of a tertiary care hospital for over 18 months and 151 infertile men with abnormal semen parameters (as per WHO 2010 criteria) were enrolled. Evaluation of lipid profile was done and its relationship with abnormal semen parameters was analyzed.Results: Significant positive correlation was seen between LDL and Triglyceride with sperm concentration and total sperm count. However, significant negative correlation was seen between Triglyceride and sperm motility and TMSC. Total and progressive motility was found to be significantly associated with total cholesterol (p<0.05). Infertile men having higher total cholesterol were found to have better total and progressive motility compared to men with less total cholesterol.Conclusions: Our findings demonstrated that lipid profile has significant correlation with semen parameters, specifically sperm concentration, count and motility.

Study of MRI lesions in severe preeclampsia and eclampsia in General Government Hospital Guntur, India

Background: Study of MRI lesions in patients with PE with severe features and eclampsia and its correlation with clinical findings and laboratory values.Methods: This prospective observational study was conducted in HDU, Department of Obstetrics and Gynecology, GGH Guntur. 50 patients with preeclampsia and eclampsia divided into two groups based on MRI findings: controls (normal MRI), cases (abnormal MRI). Results analyzed with Chi Square test and student T test.Results: Out of 50 cases, abnormal MRI findings were observed in 24 (48%) cases and 26 (52%) showed normal MRI findings. PRES lesions majority 20 cases (40%), GLIOSIS in 2 (4%) cases, CSVT in 1 (2%) patients, cerebral hemorrhage seen in 1 (2%) patient. Majority are unbooked cases n= 38 (76%), booked cases n=12 (24%). Symptoms like irritability, headache, unconsciousness, dimness of vision and seizures correlated well with positive MRI findings (P=0.001, P=0.001, P=0.002, P=0.005, P=0.000respectively). Nausea/vomiting and high BP recordings not correlated with positive MRI findings (P=0.21, P=0.312 respectively). Abnormality in blood counts, serum fibrinogen, serum uric acid, PT, APTT and PT INR are not correlated with positive MRI lesions.Conclusions: Symptoms/signs like unconsciousness, irritability, blurring of vision, headache, seizures, GCS <3 and unbooked status of patients of eclampsia and preeclampsia should be a warning for possible development of MRI brain lesions. Whereas nausea, vomiting and high BP recordings are not significantly associated with positive brain lesions in MRI.

Sarcopenia is common in ulcerative colitis and correlates with disease activity

Background/Aims@#Association of sarcopenia with disease severity in ulcerative colitis (UC) is not clearly defined. We planned to estimate the prevalence of sarcopenia in patients with UC as per the revised definition and its relation with the disease severity. @*Methods@#A cross-sectional assessment of sarcopenia in patients with UC was performed. Disease activity was graded according to complete Mayo score. Hand grip strength was assessed with Jamar hand dynamometer, muscle mass using a dual energy X-ray absorptiometry scan, and physical performance with 4-m walk test. Sarcopenia was defined as a reduction of both muscle mass and strength. Severe sarcopenia was defined as reduced gait speed in presence of sarcopenia. @*Results@#Of 114 patients (62 males, mean age: 36.49±12.41 years), 32 (28%) were in remission, 46 (40.4%) had mild-moderate activity, and 36 (31.6%) had severe UC. Forty-three patients (37.7%) had probable sarcopenia, 25 (21.9%) had sarcopenia, and 14 (12.2%) had severe sarcopenia. Prevalence of sarcopenia was higher in active disease (2 in remission, 6 in active, and 17 in severe, P<0.001). Of 14 with severe sarcopenia, 13 had severe UC while 1 had moderate UC. On multivariate analysis, lower body mass index and higher Mayo score were associated with sarcopenia. Of 37 patients with acute severe colitis, 16 had sarcopenia. Requirement of second-line therapy was similar between patients with and without sarcopenia. On follow-up (median: 18 months), there was a non-significant higher rate of major adverse events in those with sarcopenia (47.4% vs. 33.8%, P=0.273). @*Conclusions@#Sarcopenia and severe sarcopenia in UC correlate with the disease activity.

Formulation and assessment of biological properties of garcinia indica fruit extract mouthrinse as an adjunct to oral hygiene regimen: an in vitro analysis

Abstract The prevalence of gingivitis is substantial within the general population, necessitating rigorous oral hygiene maintenance. Objective This study assessed a Garcinia indica (GI) fruit extract-based mouthrinse, comparing it to a 0.1% turmeric mouthrinse and a 0.2% Chlorhexidine (CHX) mouthrinse. The evaluation encompassed substantivity, staining potential, antimicrobial efficacy and cytocompatibility. Methodology The study employed 182 tooth sections. For antimicrobial analysis, 64 extracted human teeth coated with a polymicrobial biofilm were divided into four groups, each receiving an experimental mouthrinse or serving as a control group with distilled water. Microbial reduction was assessed through colony forming units (CFU). Substantivity was evaluated on 54 human tooth sections using a UV spectrophotometer, while staining potential was examined on 64 tooth sections. Cytocompatibility was tested using colorimetric assay to determine non-toxic levels of 0.2% GI fruit extract, 0.1% Turmeric, and 0.2% CHX. Results Data were analysed with one-way ANOVA (α=0.05). Cell viability was highly significant (p<0.001) in the 0.2% GI group (64.1±0.29) compared to 0.1% Turmeric (40.2±0.34) and 0.2% CHX (10.95±1.40). For antimicrobial activity, both 0.2% GI (20.18±4.81) and 0.2% CHX (28.22±5.41) exhibited no significant difference (P>0.05) at end of 12 hours. However, 0.1% Turmeric showed minimal CFU reduction (P<0.001). Substantivity results at 360 minutes indicated statistically significant higher mean release rate in 0.1%Turmeric (12.47±5.84 ) when compared to 0.2% GI (5.02±3.04) and 0.2% CHX (4.13±2.25) (p<0.001). The overall discoloration changes (∆E) were more prominent in the 0.2% CHX group (18.65±8.3) compared to 0.2% GI (7.61±2.4) and 0.1% Turmeric (7.32±4.9) (P<0.001). Conclusion This study supports 0.2% GI and 0.1% Turmeric mouth rinses as potential natural alternatives to chemical mouth rinses. These findings highlight viability of these natural supplements in oral healthcare.

Regional-based static and dynamic alterations in Alzheimer disease: a longitudinal study / Alterações estáticas e dinâmicas de base regional na doença de Alzheimer: um estudo longitudinal

Abstract Background Alzheimer disease (AD) leads to cognitive decline and alters functional connectivity (FC) in key brain regions. Resting-state functional magnetic resonance imaging (rs-fMRI) assesses these changes using static-FC for overall correlation and dynamic-FC for temporal variability. Objective In AD, there is altered FC compared to normal conditions. The present study investigates possible region-specific functional abnormalities occurring longitudinally over 1 year. Our aim is to evaluate the potential usefulness of the static and dynamic approaches in identifying biomarkers of AD progression. Methods The study involved 15 AD and 20 healthy participants from the Alzheimer's Disease Neuroimaging Initiative 2 (ADNI2) database, tracked over 2 visits within 1 year. Using constrained-independent component analysis, we assessed FC changes across 80-regions of interest in AD over the year, examining both static and dynamic conditions. Results The average regional FC decreased in AD compared to healthy subjects at baseline and after 1 year. The dynamic condition identifies similarities with a few additional changes in the FC compared to the static condition. In both analyses, the baseline assessment revealed reduced connectivity between the following regions: right-middle-occipital and left-superior-occipital, left-hippocampus and right-postcentral, left-lingual and left-fusiform, and precuneus and left-thalamus. Additionally, increased connectivity was found between the left-superior-occipital and precuneus regions. In the 1-year AD assessment, increased connectivity was noted between the right-superior-temporal-pole and right-insular, right-hippocampus and left-caudate, right-middle-occipital and right-superior-temporal-pole, and posterior-cingulate-cortex and middle-temporal-pole regions. Conclusion Significant changes were observed at baseline in the frontal, occipital, and core basal-ganglia regions, progressing towards the temporal lobe and subcortical regions in the following year. After 1 year, we observed the aforementioned region-specific neurological differences in AD, significantly aiding diagnosis and disease tracking.

Resumo Antecedentes A doença de Alzheimer (DA) leva ao declínio cognitivo e altera a conectividade funcional (CF) em regiões-chave do cérebro. A ressonância magnética funcional em estado de repouso (rs-fMRI) avalia essas alterações usando CF estática para correlação geral e CF dinâmica para variabilidade temporal. Objetivo Na DA, há CF alterada em relação às condições normais. O presente estudo investiga possíveis anormalidades funcionais específicas da região que ocorrem longitudinalmente ao longo de um ano. Nosso objetivo é avaliar a utilidade potencial das abordagens estáticas e dinâmicas na identificação de biomarcadores da progressão da DA. Métodos O estudo envolveu 15 participantes com DA e 20 participantes saudáveis do banco de dados da Iniciativa de Neuroimagem da Doença de Alzheimer 2 (ADNI2), rastreados em duas visitas no período de um ano. Usando análise de componentes independentes e restritos, avaliamos as mudanças de CF em 80 regiões de interesse na DA ao longo do ano, examinando condições estáticas e dinâmicas. Resultados A CF regional média diminuiu na DA em comparação com indivíduos saudáveis no início do estudo e após um ano. A condição dinâmica identifica semelhanças com algumas alterações adicionais na CF em comparação com a condição estática. Em ambas as análises, a avaliação inicial revelou conectividade reduzida entre as seguintes regiões: occipital médio direito e occipital superior esquerdo, hipocampo esquerdo e pós-central direito, lingual esquerdo e fusiforme esquerdo, e precuneus e tálamo esquerdo. Além disso, foi encontrada maior conectividade entre as regiões occipital superior esquerda e precuneus. Na avaliação de DA de um ano, foi observada conectividade aumentada entre o polo temporal superior direito e o insular direito, o hipocampo direito e o caudado esquerdo, occipital médio direito e o polo temporal superior direito, e regiões posteriores do córtex cingulado e do polo temporal médio. Conclusão Mudanças significativas foram observadas no início do estudo nas regiões frontal, occipital e dos gânglios basais centrais, progredindo em direção ao lobo temporal e regiões subcorticais no ano seguinte. Após um ano, observamos as diferenças neurológicas específicas da região acima mencionadas na DA, auxiliando significativamente no diagnóstico e no rastreamento da doença.

Challenges in conservative management of placenta increta with methotrexate in nulliparous woman

Placenta increta is a severe complication of pregnancy normally diagnosed during the second trimester. Early detection could reduce the risk of hemorrhage during abortion or miscarriage; however, guidelines on first?trimester diagnosis are lacking. We describe a case of placenta increta during the second trimester with retained products of conception and its consequences followed by effective management with methotrexate.

Postoperative acute parotitis after cesarean delivery under spinal anaesthesia: a rare entity

Postoperative acute painless parotid gland swelling, which is a rare complication has been reported after caesarian section (CS) under neuraxial anaesthesia. Here, we present a parturient who suffered from acute parotitis, which developed after elective repeat CS under spinal anaesthesia.

Two case reports of accessory cavitated uterine mass-diagnostic challenges

Accessory and cavitated uterine mass (ACUM) is a rare Mullerian duct anomaly of unknown incidence, affects young women. ACUM symptoms such as dysmenorrhea and chronic pelvic pain (CPP) resistant to common analgesics and hormonal contraceptives. Here we report two ACUM cases in our hospital within one year of period with different clinical manifestations. The idea behind reporting this-cases is to increase awareness of the above entity and for concurrent surgical treatment.

Analysis of Genetic Variability and Correlation in Rice (Oryza sativa L.) Recombinant Inbred Lines (F6) for Yield and Its Component Traits

grain yield and its component traits in 150 rice recombinant inbred lines, their parents and six checks at ICAR-IIRR, Hyderabad and AHRS, Kathalagere in wet 2022. The experiments were laid out in an augmented block design with five blocks. Phenotypic coefficients of variance were higher than genotypic coefficients of variance for all the traits across the locations. A joint consideration of high heritability in broad sense (h2) and genetic advance as per cent mean estimates were obtained for plant height, number of tillers, number of productive tillers, panicle length, number of grains per panicle, test weight, grain yield per plant suggesting that the traits were primarily under genetic control. Furthermore, high heritability (h2) and GAM recorded in these characters could be explained by additive gene action. However, high estimates (h2) combined with moderate GAM recorded for days to 50% flowering could be due to non-additive gene effect. Grain yield per plant recorded positive and significant correlation with the total number of grains per panicle (0.32***, 0.30***) and number of productive tillers per plant (0.21***, 0.26***) at both the locations. This result indicates that selection based on these two traits will be highly effective for yield improvement in rice.

Symplastic leiomyoma: a rare clinicopatholgical diagnosis

Although leiomyomas are common爐his case is being reported due to its uniqueness as it posed challenges at all levels of pathological rarity and management. Symplastic leiomyoma is an unusual benign variant of leiomyoma with less likelihood of malignant transformation. In our case report we present a 28-year-old nulligravida who presented to our OPD with Fibroid uterus detected on scan and myomectomy specimen done revealed燼 rare pathological diagnosis of symplastic leiomyoma and her followup.

Study to detect infection and diagnose chorioamnionitis to aid in management of cases of preterm premature rupture of membranes in a tertiary care centre of Jharkhand

Background: The present study undertaken is to identify the risk factors causing Preterm premature rupture of membranes (pPROM) and to study fetal and maternal outcome associated with pPROM, to diagnose and manage chorioamnionitis associated with pPROM and to evaluate levels of C reactive protein (CRP).Methods: This study was conducted in the department of obstetrics and gynaecology, Rajendra institute of medical sciences from March 2019 to February 2020.50 cases of confirmed preterm premature rupture of membrane before 35 weeks of pregnancy were taken as cases and 50 cases of normal pregnancy (28-40 weeks) were taken as controls.Results: Highest incidence of premature rupture of membrane was among 20�-year (68%) age groups. Incidence of premature rupture of membrane was more in low socioeconomic status (72%). Maximum incidence of premature rupture of membrane in 31-33 weeks gestational age (52%). Most cases of premature rupture of membrane in 24�-hour group (38%). Most of study group (90%) and control group (80%) delivered by vaginal route. 11 study cases with clinical chorioamnionitis had elevated CRP (43.5 mg/l). One presented with clinical chorioamnionitis. CRP was most sensitive (92%). Total maternal morbidity was due to puerperal pyrexia (22%). Four patients with neonatal sepsis had CRP>6 mg/l. CRP and presence of polymorphs in gastric aspirate have 100% association with septicemia in neonates.Conclusions: Preterm premature rupture of membrane can be associated with adverse foetal and maternal outcome if immediate measures are not taken.

Study to determine feto maternal outcomes of programmed labor in a tertiary care hospital of Jharkhand

Background: Programmed labor aims to minimize duration and inconvenience of labor both for patient and obstetrician. The present study attempts to provide labor analgesia by using infusion paracetamol in place of conventional ketamine and tramadol.Methods: This study was conducted in the labor room of department of obstetrics and gynecology, RIMS, Ranchi from March 2019 to February 2020. 50 primigravida and 50 multigravidas were studied, with singleton pregnancy, cephalic presentation presenting with spontaneous onset of labor with Gestational age of 37-41 week.Results: 30% of patients were greater than 40 weeks gestation.65% of primigravida experienced severe pain, but only 20% of multigravidas had severe pain.60%primigravidas and 60% multigravidas (of 20% who had severe pain) experienced adequate pain relief with labor analgesia. 60 % primigravida presented with <4 cm cervical dilatation, whereas 40% multigravidas had <4 cm dilatation. 60% primigravida had shortened active phase (3.5 hrs), 60% multigravidas (2.5 hrs) which is suggestive of benefit of obstetrical analgesia in programmed labor. 90% patients had third stage labor less than 3 minutes. Only one multigravida landed in postpartum hemorrhage. All neonates had Apgar score greater than 8. There was no perinatal mortality. Only one primigravida landed in caesarean section due to arrest in second stage. 2 multigravidas had instrumental delivery. Maternal side effects like tachycardia, nausea, cervical and vaginal tears were more in primigravida.Conclusions: Participants with good response to obstetrical analgesia fared better than rest. Response was more satisfactory in primigravida in terms of labor progress.

Morpho-molecular Characterization of Carrot Soft Rot Incitant, Pectobacterium carotovorum subsp carotovoroum

Carrot is an important root vegetable which plays an important role in human health. Globally, Post harvest diseases are the major constraint in carrot production, especially soft rot which resulting in severe yield loss. Early diagnosis of these post-harvest diseases paves a way for reducing the economic losses. Carrot samples showing typical rotting symptoms were collected from markets of four different districts of Tamil Nadu and the pathogen involved were isolated. Severe carrot soft rot incidence (66.74%) was observed in samples collected from Ooty area of The Nilgiris district and the least disease incidence of (16.21%) was recorded in Perundurai of Erode district. Pathogenicity of soft rot pathogen were conducted and the virulent isolates were identified based on Percent Disease Index (PDI) showing >50% rotting falls under disease grade 9 using disease grade scale (0 to 9). The bacterial isolates (KPB-7 and OCB-5) causing soft rot were characterized using various biochemical assays where in they showed positive response for methyl red, H2S gas production, KOH and catalase tests besides showing negative response for gram’s reaction. Furthermore, molecular characterization of 16s rRNA region revealed the soft rot isolate (KPB-7) as Pectobacterium carotovorum subsp carotovorum (with an accession number OR251119).

Evaluation and Performance of Integrated Crop Management in Chilli in Rainfed Tracts of Prakasam District, Andhra Pradesh, India

Chilli is an important high value spice crop, its integrated crop management is an important area for the welfare andlivelihood security of farmers. Most of the farmers of Prakasam district of Andhra Pradesh are growing wide varieties and cultivars of chilli but so far the research findings on chilli integrated crop management were less aware. To know the yield potential of integrated crop management and its economic impact, evaluation on integrated crop management was conducted at Chandhaluru and Nallaguntla Guedm villages. The adopted package of practices was seed rate @1kg/ha, spacing 60x45cm, FYM 15t/ha, Urea, single super and muriate of potash256:150:80 kg/acre. There was wide variation between integrated crop management and farmers practice in fruit yield and economic returns. The results on yield and economic returns indicated that chilli integrated crop management was found superior to farmers practice. Integrated crop management could obtain 124 fruits per plant and yield of 47.00q/ha, thirps incidence (24.3%), whitefly incidence (9.67 %) and fruit rot infestation (6.0%). Whereas,in farmers practicefruits obtained were99per plant and yield of 43.00q/ha, thripsincidence (44.67 %),whiteflyincidence (28.33) and fruit rot(18 %) with a net income of Rs220000/- and B:C ratio 1: 1.88 compared to farmers practice with a net income of Rs113333/-with B:C ratio 1:1.36. The integrated crop management percent yield increased over farmers practices8.5 per cent. It was concluded that integrated crop management could help to improve the economy of the farmers.

Efficacy of Some Essential Oil for the Management of Rice Weevil (Sitophilus oryzae) on Stored Wheat

The experiment was conducted in Completely Block Design (CRD) at the laboratory of the Department of Entomology, Naini Agriculture Institute Sam Higginbottom University of Agriculture, Science and Technology, Prayagraj, Uttar Pradesh with three replications seven treatments and untreated control against Rice Weevil Sitophilus oryzae (L.) i.e.T1 (Neem Oil), T2 (Clove Oil), T3 (Lavender Oil), T4 (Karanj Oil), T5 (Eucalyptus oil), T6 (Lemongrass Oil), and T7 (Tea tree Oil) and T0 (control). The experiment was conduct on the efficacy of different essential oil for the management of rice weevil, Sitophilus oryzae and adult mortality at 24, 48 and 72 hrs of exposure. The treatments included Neem Oil (0.5ml/lit), Clove Oil (0.5ml/lit), Lavender Oil (0.4ml/lit), Karanja Oil (0.4ml/lit), Eucalyptus Oil (0.5ml/lit), Lemon grass Oil (0.5ml/lit) and Tea tree Oil (0.5ml/lit). Among the treatments the largest number of mortality was observed in neem oil (83.33%), followed by karanj oil (77.77%), and least mortality was observed in the lavender oil (31.11%), rest of the treatments were found intermediate as followed by clove oil (67.77%), followed by eucalyptus oil (57.77%), followed by lemon grass oil (54.44%) and tea tree oil (51.10%). Percent weight loss of treated wheat grains at intervals of 30, 60 and 90 days after treatment. The results revealed that neem oil (7.32%), followed by karanj oil (11.99%). Least weight loss was recorded in lavender oil (41.06%). Whereas rest of treatments were found intermediate. And the highest germination was found in neem oil treated wheat seeds. The present study clearly revealed that these naturally occurring indigenous plant products could be used to manage the storage insect pests in wheat.

Selective Isolation and Characterization of Phytophthora infestans from Potatoes Using Rye Agar Media in India

Phytophthora infestans is a pathogen that causes late blight, a major disease of potatoes. The isolation of P. infestans from infected potato plants using agar media has been challenging. This study investigated the use of Rye A and Rye B agar media for the isolation of P. infestans from infected potato tubers collected from the Nilgiris district of Tamil Nadu during 2022. The media were evaluated for hyphal growth, sporangial production, oospore formation, and long-term storage of P. infestans. Phenotypic diagnosis based on cultural and morphological characteristics confirmed the identity of P. infestans. The results were confirmed by a molecular identification test using primers specific to P. infestans. Pathogenicity tests were carried out to assess the virulence of the isolates. This study provides a useful protocol for the selective isolation and characterization of P. infestans, the potato late blight pathogen.

Physiological Changes in Okra (Abelmoschus esculentus L.) by Postharvest Application with Hexanal Containing Aqueous Formulations

Aim: Okra is a vegetable that holds a significant share in both domestic and export markets, but it is prone to desiccation and fungal spoilage, leading to a short shelf life. A laboratory study was undertaken to determine the effects of hexanal containing aqueous formulation to improve the shelf life of okra with the objective to maintain the best quality of pods for end consumer acceptance.Study Design: Factorial Completely Randomized Design was followed with three replications.Place and Duration of Study: The study was conducted in laboratory conditions, Department of Vegetable Science, Horticultural College and Research Institute, Coimbatore during 2021-2022Methodology: In this study, TNAU released nanoformulation– TNAU FRUITY FRESH – ENHANCED FRESHNESS FORMULATION consisting of 2% Hexanal, 10% Formulation ingredients, 88% Deionized filler. and hexanal was used at varying concentrations for imposing treatments on freshly harvested, uniform sized undamaged tender pods of bhendi hybrid COBh H4 (TNAU released hybrid) using spray and dip methods under ambient and cold storage conditions and physiological parameters were assessed.Results: As per the investigation, 2% Enhanced Freshness Formulation using dip method in cold storage conditions slower the physiological loss in weight, preserves the L*, a*, b* value, extend the shelf life and preserved the quality for consumer acceptance during storage 9 days as compared to control.Conclusion: The study gave the knowledge of hexanal containing aqueous formulation and their effectiveness to use as post-harvest technology tool for okra.

Mucocutaneous manifestations of COVID-19-associated mucormycosis: A retrospective cross-sectional study

Background: Cutaneous mucormycosis has shown a significant upsurge during the COVID-19 pandemic. Due to the rapid progression and high mortality of cutaneous mucormycosis in this context, it is important to identify it early. However, very few studies report detailed clinical descriptions of cutaneous mucormycosis in COVID-19 patients. Objectives: To describe mucocutaneous lesions of COVID-19-associated mucormycosis based on clinical morphology and attempt to correlate them with radiological changes. Methods: A retrospective cross-sectional study was conducted at a tertiary care centre from 1st April to 31st July 2021. Eligibility criteria included hospitalised adult patients of COVID-19-associated mucormycosis with mucocutaneous lesions. Results: All subjects were recently recovering COVID-19 patients diagnosed with cutaneous mucormycosis. One of fifty-three (2%) patients had primary cutaneous mucormycosis, and all of the rest had secondary cutaneous mucormycosis. Secondary cutaneous mucormycosis lesions presented as cutaneous-abscess in 25/52 (48%), nodulo-pustular lesions in 1/52 (2%), necrotic eschar in 1/52 (2%) and ulcero-necrotic in 1/52 (2%). Mucosal lesions were of three broad sub-types: ulcero-necrotic in 1/52 (2%), pustular in 2/52 (4%) and plaques in 1/52 (2%). Twenty out of fifty-two patients (38%) presented with simultaneous mucosal and cutaneous lesions belonging to the above categories. Magnetic resonance imaging of the face showed variable features of cutaneous and subcutaneous tissue involvement, viz. peripherally enhancing collection in the abscess group, “dot in circle sign” and heterogeneous contrast enhancement in the nodulo-pustular group; and fat stranding with infiltration of subcutaneous tissue in cases with necrotic eschar and ulcero-necrotic lesions. Limitations: The morphological variety of cutaneous mucormycosis patients in a single-centre study like ours might not be very precise. Thus, there is a need to conduct multi-centric prospective studies with larger sample sizes in the future to substantiate our morphological and radiological findings. Conclusions: COVID-19-associated mucormycosis patients in our study presented with a few specific types of mucocutaneous manifestations, with distinct magnetic resonance imaging findings. If corroborated by larger studies, these observations would be helpful in the early diagnosis of this serious illness.