Oral beta-hydroxybutyrate alleviates COVID-19 related acute respiratory distress syndrome: A randomized, single-blind, placebo-controlled trial.

BACKGROUND: Acute respiratory distress syndrome (ARDS) is a lung complication of COVID-19 that requires intensive care and ventilation. Beta-hydroxybutyrate (BHB) is a ketone body that can modulate metabolism and inflammation in immune cells and lung tissues. We hypothesized that oral BHB could alleviate COVID-19 related ARDS by reducing pro-inflammatory cytokines and increasing anti-inflammatory cytokines. METHODS: We randomized 75 patients with mild (as per Berlin criteria) ARDS symptoms to receive oral 25 g twice daily or placebo for five days. The primary outcome was the change in pro-inflammatory cytokines (Interleukin-1ß, Interleukin-6, interleukin-18, tumour necrosis factor-alpha) and anti-inflammatory cytokine (interleukin-10) from baseline to day 5. The secondary outcomes were the change in BHB levels from baseline to day 5, the number of hospitalization days, and the occurrence of adverse events. RESULTS: Treatment with formulated BHB resulted in a significant decrease in pro-inflammatory cytokines; Interleukin-1ß (p = 0.0204), Interleukin-6 (p = 0.0309), interleukin-18 (p = 0.0116), tumour necrosis factor-alpha (p = 0.0489) and increase in interleukin-10 (p = 0.0246) compared treatment with placebo. Importantly, higher BHB levels (p = 0.0001) were observed after supplementation; additionally, patients who underwent this approach were hospitalized for fewer days. No serious adverse events were reported. CONCLUSION: Beta-hydroxybutyrate, an oral adjunct therapy, has shown promising results in ameliorating symptoms of ARDS. This includes reduced inflammation, oxidative stress, and decreased patient fatigue levels. Further study with a large sample size is warranted to assess the potential of BHB therapy's effectiveness in reducing the development of severe illness. CLINICAL TRIAL REGISTRATION: (http://ctri.nic.in/CTRI/2021/03/031790).

Genistein mitigates nitroglycerine-induced migraine: modulation of nitric oxide-mediated vasodilation and oxidative stress.

Migraine is a widespread brain condition described by frequent, recurrent episodes of incapacitating, moderate-to-severe headaches with throbbing pain that are usually one-sided. It is the 2nd most debilitating state lived with disability in terms of years, with a prevalence rate of 15-20%. Significant drops in estrogen levels have been associated with triggering acute migraine attacks in certain cases. Phytoestrogens are plant-derived compounds that resemble estrogen in structure, enabling them to imitate estrogen's functions in the body by attaching to estrogen receptors. Thus, the study was aimed to explore the protective effect of genistein against migraine. Moreover, the role of nitric oxide was also studied in the observed effect of genistein. Nitric oxide (NO) is implicated in migraine pathophysiology due to its role in promoting cerebral vasodilation and modulation of pain perception. Exploring L-NAME, a nitric oxide synthase inhibitor in migraine research helps scientists better understand the role of NO in migraine. Nitroglycerine treatment significantly increased the facial-unilateral head pain and spontaneous pain, as evidenced by the increased number of head scratching and groomings. Nitroglycerine treatment also induced anxiogenic behavior in mice. A significant reduction in the number of entries in the light phase and open arm, respectively. Biochemical analysis indicated a significant increase in inflammatory and oxidative stress in the nitroglycerin group. A significant increase and decrease in brain TBARS and GSH were observed with nitroglycerine treatment, respectively. Moreover, nitroglycerine treatment has uplifted the serum TNF-α level. Genistein (20 mg/kg) significantly mitigated the facial-unilateral head pain, spontaneous pain, photophobia, and anxiety-like behavior induced by nitroglycerine. Biochemical analysis showed that genistein (20 mg/kg) significantly abrogated the nitroglycerine-induced lipid peroxidation and increased serum TNF-α level. Genistein treatment also upregulated the brain GSH level and downregulated the serum TNF-α level. The L-NAME-mediated alleviation of the protective effect of genistein might be attributed to the vasodilatory effect of L-NAME. Conclusively, it can be suggested that genistein might provide relief from migraine pain by inhibiting nitric oxide-mediated vasodilation and oxidative stress.

Propellant Free Pressurized Spray System of Etodolac to Manage Acute Pain Conditions: In Vitro and In Vivo Evaluation.

This study aimed to develop a propellant-free topical spray formulation of Etodolac (BCS-II), a potent NSAID, which could be beneficial in the medical field for the effective treatment of pain and inflammation conditions. The developed novel propellant-free spray formulation is user-friendly, cost-effective, propellant-free, eco-friendly, enhances the penetration of Etodolac through the skin, and has a quick onset of action. Various formulations were developed by adjusting the concentrations of different components, including lecithin, buffering agents, film-forming agents, plasticizers, and permeation enhancers. The prepared propellant-free spray formulations were then extensively characterized and evaluated through various in vitro, ex vivo, and in vivo parameters. The optimized formulation exhibits an average shot weight of 0.24 ± 0.30 ml and an average drug content or content uniformity of 87.3 ± 1.01% per spray. Additionally, the optimized formulation exhibits an evaporation time of 3 ± 0.24 min. The skin permeation study demonstrated that the permeability coefficients of the optimized spray formulation were 21.42 cm/h for rat skin, 13.64 cm/h for mice skin, and 18.97 cm/h for the Strat-M membrane. When assessing its potential for drug deposition using rat skin, mice skin, and the Strat-M membrane, the enhancement ratios for the optimized formulation were 1.88, 2.46, and 1.92, respectively against pure drug solution. The findings from our study suggest that the propellant-free Etodolac spray is a reliable and safe topical formulation. It demonstrates enhanced skin deposition, and improved effectiveness, and is free from any skin irritation concerns.

Pre-clinical and cellular safety assessment of oral administered DHA rich microalgae oil from Schizochytrium sp. (Strain ATCC-20889): acute, sub-chronic and genotoxicity.

The lack of toxicity data for DHA-rich oil from Schizochytrium sp. (Strain ATCC-20889) leads to its exclusion from the Qualified Presumption of Safety list. Therefore, present study addresses toxicity evaluation of DHA-rich microalgae oil using ex-vivo (cytotoxicity assay) and in-vivo methods (acute (OECD 423 guidelines), sub-chronic (OECD 452 guidelines), and genotoxicity assay). The ex-vivo results showed >90% cell viability of Caco-2 cells after 48 h of treatment (200 µg/mL of DHA). Additionally, the in-vivo acute toxicity study found that microalgae oil was nontoxic and classified under category 5 molecule according to OECD 423 guidelines with a highest degree of safety at 2000 mg/kg b.w. The in-vivo sub-chronic study revealed no significant mortality and changes in feed intake, body weight, haematological, biochemical, neurological, and urine parameters after repeated 180-days administration of DHA-rich microalgae oil at 250 mg/kg, 500 mg/kg, and 1000 mg/kg. Moreover, histopathology evaluation, comet assay, chromosomal aberration, and micronuclei assay also confirmed the nontoxic behavior of DHA-rich oil. Thus, the results from the ex-vivo and in-vivo studies indicate that DHA-rich oil from Schizochytrium sp. (Strain ATCC-20889) is safe for use as a novel food, and can be included in infants, adults, pregnant women, and children formula.

High frequency of ofloxacin resistance patterns of Mycobacterium leprae from India: An indication to revisit second line anti-leprosy treatment regimen.

OBJECTIVES: Drug resistance in leprosy is an emerging concern, leading to treatment failures, recurrences, and potential spread of resistant Mycobacterium leprae in the community. In this study, we aimed to assess drug resistance prevalence and patterns amongst leprosy patients at a tertiary care referral hospital in India. METHODS: Mutations in drug resistance determining regions for dapsone, rifampicin, and ofloxacin of the M. leprae genome in DNA extracted from skin biopsies of 136 leprosy patients (treatment-naive = 67, with persistent skin lesions = 35, with recurrence = 34) were analysed by polymerase chain reaction followed by Sanger sequencing. Wild-type strain (Thai-53) was used as a reference strain. RESULTS: Resistance mutations were identified in a total of 23 patients, constituting 16.9% of the cohort. Within this subset of 23 cases, resistance to ofloxacin was observed in 17 individuals (12.5%), while resistance to both dapsone and rifampicin was detected in three patients each (2.2% for both). The occurrence of ofloxacin resistance showed minimal disparity between recurrent and treatment-naive cases, at 17.6% and 16.4%, respectively. Dapsone resistance emerged in two treatment-naive cases and one case with persistent skin lesions. Notably, none of the treatment-naive cases or those with recurrence/relapse exhibited rifampicin resistance. Subsequently, no statistically significant correlation was identified between other clinical variables and the presence of antimicrobial resistance. CONCLUSIONS: The occurrence of resistance to the current multidrug therapy regimen (specifically dapsone and rifampicin) and to ofloxacin, a secondary antileprosy medication in M. leprae, represents a concerning scenario. This calls for an expansion towards bactericidal drug options and the establishment of robust surveillance for drug resistance in countries burdened with high leprosy rates. Moreover, the introduction of stringent antimicrobial stewardship initiatives is imperative. As a single centre study, it represents a limited, cross-sectional view of the real situation in the field.

Removal of cadmium and arsenic from water through biomineralization.

Due to anthropogenic activities, heavy metals such as cadmium (Cd) and arsenic (As) are one of the most toxic xenobiotics contaminating water, thus affecting human health and the environment. The objective of the present investigation was to study the effect of ureolytic bacteria Bacillus paramycoides-MSR1 for the bioremediation of Cd and As from contaminated water. The B. paramycoides showed high resistance to heavy metals, Cd and As, with minimum inhibitory concentration (MIC) of 12.84 µM and 48.54 µM, respectively. The urease activity and calcium carbonate (CaCO3) precipitation were evaluated in artificial wastewater with different concentrations of Cd (0, 10, 20, 30, 40, 50, and 60 µM) and As (0, 20, 40, 60, 80, and 100 µM). The maximum urease activity in Cd-contaminated artificial wastewater was observed after 96 hours, which showed a 76.1% decline in urease activity as the metal concentration increased from 0 to 60 µM. Similarly, 14.1% decline in urease activity was observed as the concentration of As was increased from 0 to 100 µM. The calcium carbonate precipitation at the minimum inhibitory concentration of Cd and As-contaminated artificial wastewater was 189 and 183 mg/100 ml, respectively. The percentage removal of metal from artificially contaminated wastewater with varied concentrations was analyzed using atomic absorption spectroscopy (AAS). After 168 hours of incubation, 93.13% removal of Cd and 94.25% removal of As were observed. Microstructural analysis proved the presence of calcium carbonate in the form of calcite, confirming removal of cadmium and arsenic by microbially induced calcium carbonate precipitation (MICCP) to be promising technique for water decontamination.

Revolutionizing Pharmaceutical Industry: The Radical Impact of Artificial Intelligence and Machine Learning.

This article explores the significant impact of artificial intelligence (AI) and machine learning (ML) on the pharmaceutical industry, which has transformed the drug development process. AI and ML technologies provide powerful tools for analysis, decision-making, and prediction by simplifying complex procedures from drug design to formulation design. These techniques could potentially speed up the development of better medications and drug development processes, improving the lives of millions of people. However, the use of these techniques requires trained personnel and human surveillance for AI to function effectively, if not there is a possibility of errors like security breaches of personal data and bias can also occur. Thus, the present review article discusses the transformative power of AI and ML in the pharmaceutical industry and provides insights into the future of drug development and patient care.

Accuracy Differences in Cannabis Retailer Information Ascertained from Webservices and Government-Maintained State Registries Across US States Legalizing the Sale of Cannabis in 2019.

Cannabis retailer locations used to investigate geographic cannabis access are frequently ascertained from two sources: 1) webservices which provide locations of cannabis retailers (e.g., Yelp) or 2) government-maintained registries. Characterizing the operating status and location information accuracy of cannabis retailer data sources on a state-by-state level can inform research examining the health implications of cannabis legalization policies. This study ascertained cannabis retailer name and location from webservices and government-maintained registries for 26 states and the District of Columbia legalizing cannabis sales in 2019. Validation subsamples were created using state-level sequential sampling. Phone surveys were conducted by trained researchers for webservice samples (n=790, November 2019 - May 2020) and government-maintained registry (n=859, February - June 2020) to ascertain information about operating status and location. Accuracy was calculated as the percent agreement among subsample and phone survey data. For operating status and location, webservice derived data was 78% (614/790) and 79% (484/611) accurate, whereas government-maintained registry derived data was 76% (657/859) and 95% (622/655) accurate, respectively. Fifty-nine percent (15/27) of states and the District of Columbia had over 80% accuracy for operating status and 48% (13/27) states had over 80% accuracy for location information with both data sources. However, government-maintained registry derived information was more accurate in 33% (9/27) states for operating status and 41% (11/27) states for location information. Both data sources had similar operating status accuracy. Research using spatial analysis may prefer government-maintained registry derived data due to high location information accuracy, whereas studies looking at broad trends across states may prefer webservice derived. State level COVID-19 restrictions had minimal impact on ascertainment of cannabis retailer operating status and location information via phone survey derived from webservices and government-maintained registries.

A Comprehensive Analysis of Deep Learning-Based Approaches for Prediction and Prognosis of Infectious Diseases.

Artificial intelligence is the most powerful and promising tool for the present analytic technologies. It can provide real-time insights into disease spread and predict new pandemic epicenters by processing massive amount of data. The main aim of the paper is to detect and classify multiple infectious diseases using deep learning models. The work is conducted by using 29,252 images of COVID-19, Middle East Respiratory Syndrome Coronavirus, Pneumonia, normal, Severe Acute Respiratory Syndrome, tuberculosis, viral pneumonia, and lung opacity which has been collected from various disease datasets. These datasets are used to train the deep learning models such as EfficientNetB0, EfficientNetB1, EfficientNetB2, EfficientNetB3, NASNetLarge, DenseNet169, ResNet152V2, and InceptionResNetV2. The images have been initially graphically represented using exploratory data analysis to study the pixel intensity and find anomalies by extracting the color channels in an RGB histogram. Later, the dataset has been pre-processed to remove noisy signals using image augmentation and contrast enhancement techniques. Further, feature extraction techniques such as morphological values of contour features and Otsu thresholding have been applied to extract the feature. The models have been evaluated on the basis of various parameters, and it has been discovered that during the testing phase, the InceptionResNetV2 model generated the highest accuracy of 88%, best loss value of 0.399, and root mean square error of 0.63.

Carrier transport and photoconductivity properties of BN50/NiO50 nanocomposite films.

BN50/NiO50 and Au-loaded BN50/NiO50 nanocomposite films were separately fabricated on the glass substrates for carrier transport and photoconductivity properties. X-ray diffraction pattern of the films show the hexagonal structure of BN and presence of defect states by Nelson Riley factor analysis. Morphological images show spherical shaped particles with highly porous structure. The incorporation of NiO may hindered growth of BN layers and resulted in spherical particles. Temperature-dependent conductivity describes semiconductor transport behaviour for deposited nanocomposite films. Thermal activation conduction with low activation energy (∼0.308 eV) may be responsible for the resulting conductivity. Further, the light intensity dependent photoelectrical properties of BN50/NiO50 and Au-loaded BN50/NiO50 nanocomposites have been explored. The effect of Au nanoparticles loading on enhanced photo-conductivities (∼22% increase) than bare nanocomposite film has been elaborated by proposed mechanism. This study provided the insightful information for carrier transport and photoconductivity of BN-based nanocomposites.

Highly fluorescent nickel based metal organic framework for enhanced sensing of Fe3+ and Cr2O72- ions.

Heavy metal contamination has sparked widespread concern among the populace. The significant issues necessitate the creation of high-performance fluorescent pigments that can identify harmful elements in water. The present study deals with metal organic framework [MOF] based on nickel [Ni-BDC MOF]. The Ni-BDC MOF was prepared by facile solvothermal method using nickel nitrate hexahydrate and terephthalic acid ligand as precursors. The MOF was characterized by various techniques in order to examine the crystal, morphological, structural, composition, thermal and optical properties. The detailed characterizations revealed that the synthesized Ni-BDC MOF are well-crystalline with high purity and possessing 3D rhombohedral microcrystals with rough surface. The MOF demonstrate good luminescence performance and excellent water stability. According to the Stern Volmer plot, the tests set up under optimized conditions demonstrate a linear correlation between the fluorescence intensity and concentration of both ions, i.e. Fe3+, and Cr2O72- ions. The linear range and detection limit for Fe3+ and Cr2O72- were found to be 0-1.4 nM and 0.159 nM, and 0-1 nM and 0.120 nM, respectively. The mechanisms for the selective detection of cations and anions were also explored. The recyclability for the prepared MOF was checked up to five cycles which showed excellent stability with just a slight reduction in efficiency. The constructed sensor was also used to assess the presence of Fe3+ and Cr2O72- ions in actual water samples. The results of the different experiments revealed that the prepared MOF is a good material for detecting Fe3+ and Cr2O72- ions.

Preparation and Characterisation of Liposomes of Bergenia Ciliata Extract and Evaluation of their Hepatoprotective Activity.

Acute liver damage (ALD) can cause biochemical and pathological changes, which can lead to major complications and even death. The goal of the study was to examine the therapeutic efficacy of liposomes of Bergenia ciliata extract against thioacetamide-induced liver damage in rats. Liposomal batches of B. ciliata extract were prepared by altering the kind and amount of phospholipids and characterized through various physiochemical properties such as laser diffraction, TEM, encapsulation efficiency, stability and in-vitro release studies. In-vivo hepatoprotective studies were performed on TAA-induced acute hepatic damage model. Further, in-silico studies of bergenin against the three hepatic damage markers viz. TGF-ß1, TNF-α and interleukin-6 were also performed. Laser diffraction and TEM showed that most stable liposome batch of B. ciliata extract were in the range of 678-1170 nm with encapsulation efficiency of 84.3±3.5. Extract was found to be rapidly dissociated from B. ciliata liposomes in HCl than PBS, according to in-vitro release data. In-vivo data revealed a significant decline in LFT indicators, amelioration of pathological changes and high bergenin bioavailability in the liposomal group. Protective activity of bergenin against ALD targets like TGF-ß1, TNF-α and interleukin-6 was anticipated via molecular docking research. As a result, the current findings of the study indicate that B. ciliata liposomes and bergenin have promising ameliorative potential in the management of ALD.

Novel Hyaluronic Acid ethosomes based gel formulation for topical use with reduced toxicity, better skin permeation, deposition, and improved pharmacodynamics.

Hyaluronic Acid (HA) has been applied as an anti-ageing molecule in the form of topical products. Current topical commercial formulations of HA face the limitations of very small and stagnant skin permeation, thereby demanding enduring administration of the formulation to sustain its action. In this study, Lipid-based nanocarriers in the form of ethosomes were formulated in a 1% w/w HA strength and were extensively evaluated in vitro, ex-vivo, and in vivo parameters along with a comparison to it's commercial counterpart. The optimised ethosomes-based HA gel formulation revealed required pH (6.9 ± 0.2), small globule size (1024 ± 9 nm), zeta potential of -6.39 ± 0.2 mV, and 98 ± 1.1% HA content. The ex vivo skin permeation and deposition potenwere conferred on synthetic membrane Strat-M, Human cadaver skin, mice skin, rat skin, and pig skin, and both parameters were found to be much higher in comparison to the commercial topical formulation. Skin deposition capacity of the optimised HA formulation was further confirmed by Scan Electron Microscopy (SEM) and Confocal Laser Scanning Microscopy (CLSM) and it was observed that the developed ethosomal gel formulation got deposited more on the treated skin. The in vivo anti-ageing effect of optimised ethosomal gel on rats was found to be greater when compared to commercial formulation of HA and the developed carrier-based system proved to deliver the HA molecule in very small amounts into the systemic circulation. The results endorse the ethosomal carrier-based formulation of HA as a attractive technique for better local bioavailability of HA.

Nascent Nanoformulations as an Insight into the Limitations of the Conventional Systemic Antifungal Therapies.

More than 150 million people have significant fungal diseases that greatly impact health care and economic expenditures. The expansion of systemic fungal infections and invasive mycoses is being driven by an increase in the number of immunocompromised patients and the recent COVID-19 patients, especially severely ill. There have been numerous cases of fungal infections linked to COVID-19, with pulmonary aspergillosis dominating at first but with the subsequent appearance of mucormycosis, candidiasis, and endemic mycoses. Candida spp. is the most frequent pathogen, with approximately 1 billion infections yearly, among other species causing the most prevalent invasive fungal infections. The importance of recognizing the epidemiological shifts of invasive fungal infections in patient care cannot be overstated. Despite the enormous antifungal therapies available, these infections are difficult to diagnose and cause high morbidity and mortality rates. Treatment choices for systemic fungal infections are severely limited due to the limitations of conventional therapy effectiveness and drug toxicities. So the researchers are still looking for novel therapeutic options, such as carrier-based approaches that are convenient and cost-effective with high and long-lasting fungal infection cure rates with reduced toxicities. The focus of this study is on summarizing the nanotechnology, immunotherapy methods and the drugs under clinical trials that have been employed in treatment as carrier-based antifungal formulations. Most of these have been reported to be promising strategies with broad-spectrum antifungal action and the potential to overcome antibiotic resistance mechanisms. We speculate that this review summarized the current knowledge to its best that will help the future developments of new antifungal therapies.

rGO-WO3 Heterostructure: Synthesis, Characterization and Utilization as an Efficient Adsorbent for the Removal of Fluoroquinolone Antibiotic Levofloxacin in an Aqueous Phase.

Herein, the heterostructure rGO-WO3 was hydrothermally synthesized and characterized by HRTEM (high-resolution transmission electron microscopy), FESEM (field emission scanning electron microscopy), XRD (X-ray diffraction), FT-IR (Fourier transform infrared spectroscopy), XPS (X-ray photoelectron microscopy), nitrogen physisorption isotherm, Raman, TGA (thermogravimetric analysis) and zeta potential techniques. The HRTEM and FESEM images of the synthesized nanostructure revealed the successful loading of WO3 nanorods on the surface of rGO nanosheets. The prepared heterostructure was utilized as an efficient adsorbent for the removal of a third-generation fluoroquinolone antibiotic, i.e., levofloxacin (LVX), from water. The adsorption equilibrium data were appropriately described by a Langmuir isotherm model. The prepared rGO-WO3 heterostructure exhibited a Langmuir adsorption capacity of 73.05 mg/g. The kinetics of LVX adsorption followed a pseudo-second-order kinetic model. The adsorption of LVX onto the rGO-WO3 heterostructure was spontaneous and exothermic in nature. Electrostatic interactions were found to have played a significant role in the adsorption of LVX onto the rGO-WO3 heterostructure. Thus, the prepared rGO-WO3 heterostructure is a highly promising material for the removal of emerging contaminants from aqueous solution.

Micro RNAs as Emerging Therapeutic Targets in Liver Diseases.

MicroRNAs (MiRNAs) are endogenous non-coding small RNA molecules that regulate gene expression in plants, animals and some viruses. Both normal and pathological liver processes are regulated by miRNAs. Recent research indicated that miRNAs have been implicated in liver diseases caused by viral hepatitis (Hepatitis B and Hepatitis C), metabolic problems, alcohol and drug abuse. Because altered miRNA expression is linked to liver metabolic dysregulation, liver damage, liver fibrosis, and tumour growth, miRNAs are promising therapeutic targets for the detection and treatment of liver diseases. In this review, we summarise the current knowledge about the role of microRNAs in acute and chronic liver diseases, including hepatocellular carcinoma. We cover the miRNA-based therapy for liver disorders as well as the use of miRNAs as biomarkers for early diagnosis, prognosis and assessment of liver diseases. The investigation of miRNAs in liver diseases will provide a better understanding of the pathogeneses, identification of biomarkers and therapeutic targets for liver diseases in the future.

Adaptations to the first wave of the COVID-19 pandemic by private sector tuberculosis care providers in India.

Background: India's dominant private healthcare sector is the destination for 60-85% of initial tuberculosis care-seeking. The COVID-19 pandemic in India drastically affected TB case notifications in the first half of 2020. In this survey, we assessed the impact of the first wave of COVID-19 in India on private providers, and changes they adopted in their practice due to the pandemic. Methods: The Joint Effort for Elimination of TB (JEET) is a nationwide Global Fund project implemented across 406 districts in 23 states to extend quality TB services to patients seeking care in private sector. We conducted a rapid survey of 11% (2,750) of active providers engaged under JEET's intense Patient Provider Support Agency (PPSA) model across 15 Indian states in Q1 (February-March) of 2021. Providers were contacted in person or telephonically, and consenting participants were interviewed using a web-based survey tool. Responses from participants were elicited on their practice before COVID-19, during the 2020 lockdowns (March-April 2020) and currently (Q1 2021). Data were adjusted for survey design and non-response, and results were summarised using descriptive statistics and logistic regression. Results: Of the 2,750 providers sampled, 2,011 consented and were surveyed (73 % response). Nearly 50 % were between 30 and 45 years of age, and 51 % were from Uttar Pradesh, Maharashtra and Gujarat. Seventy percent of providers reported reduced daily out-patient numbers in Q1 2021 compared to pre-COVID times. During the lockdown, 898 (40 %) of providers said their facilities were closed, while 323 (11 %) offered limited services including teleconsultation. In Q1 2021, 88 % of provider facilities were fully open, with 10 % providing adjusted services, and 4 % using teleconsultation. Only 2 % remained completely closed. Majority of the providers (92 %) reported not experiencing any delays in TB testing in Q1 2021 compared to pre-COVID times. Only 6 % reported raising costs at their clinic, mostly to cover personal protective equipment (PPE) and other infection control measures, although 60-90 % implemented various infection control measures. Thirty-three percent of TB providers were ordering COVID-19 testing, in addition to TB testing.To adapt, 82% of survey providers implemented social distancing and increased timing between appointments and 83% started conducting temperature checks, with variation by state and provider type, while 89% adopted additional sanitation measures in their facilities. Furthermore, 62% of providers started using PPE, and 13% made physical changes (air filters, isolation of patient areas) to their clinic to prevent infection. Seventy percent of providers stated that infection control measures could decrease TB transmission. Conclusion: Although COVID-19 restrictions resulted in significant declines in patient turn-out at private facilities, our analysis showed that most providers were open and costs for TB care remained mostly the same in Q1 2021. As result of the COVID-19 pandemic, several positive strategies have been adapted by the private sector TB care providers. Since the subsequent COVID-19 waves were more severe or widespread, additional work is needed to assess the impact of the pandemic on the private health sector.

Bilateral blindness in a young male of rhino-orbital-cerebral mucormycosis: A case report.

The storm of COVID-19-associated mucormycosis (CAM) has not yet settled, and it has proven itself a disfiguring and potentially life-threatening disease, complicating the course of COVID-19 infection. Mucormycosis is a rare but devastating fungal infection caused by filamentous fungi of the family Mucoraceae. We report a rare case of a 37-year-old diabetic male with bilateral rhino-orbital-cerebral mucormycosis (ROCM) where it leads to bilateral central retinal artery occlusion (CRAO) as manifestation of the disease. Bilateral CRAO secondary to ROCM is extremely rare. A strong suspicion of CAM in uncontrolled diabetics can result in early diagnosis and management.

Assessment of the Radio-contrast Media-Induced Self-Reported Adverse Drug Reactions in a Tertiary Care Hospital of North India: A Prospective Study.

Background: Radio-contrast media are the agents which are used on daily basis in the radiological practice for either diagnostic or therapeutic purpose. Currently used agents are considered to be safe but not devoid of side effects. Objectives: Objectives of the study were to assess the incidence of adverse drug reactions (ADRs) in the patients who receive radiographic contrast media for computed tomography (CT) and intravenous pyelography (IVP), to stratify the ADRs into different types based on their time of appearance and as per their severity. Materials and Methods: A prospective and observational study of 1-year duration was done on all the patients who received radio-contrast media (Iohexol) intravenously for CT and IVP in the radiodiagnosis department. Patients who experienced ADRs were recorded for the basic demographic characteristics and types of ADRs. Stratification of ADRs as per their severity was done using common terminology criteria for adverse events scale and Modified Hartwig and Siegel ADR Severity Assessment Scale, and casualty assessment was done using Naranjo's Algorithm. Results: Out of the total 3522 patients who were included in the study, eight patients got 12 suspected ADRs with some of the patients having more than one type of ADR. The most frequent ADR was nausea and vomiting (25%), followed by fever, chills, or sweating. Incidence of ADRs was 0.23%. All the ADRs were acute and occurred within 30 min of contrast administration. As per the severity scales used, all the ADRs were mild (75%) to moderate (25%) in nature with none of the reactions to be severe. Causality assessment showed 87.5% of the reactions to be "probable" in nature. Conclusion: Low osmolar nonionic radio contrast media are associated with very low incidence of ADRs in the North Indian population.

Spectrum of magnetic resonance imaging findings in post-COVID-19 patients presenting with rhino-orbito-cerebral mucormycosis in a teaching hospital in Malwa region of Punjab.

Background: Rhino-orbito-cerebral-mucormycosis (ROCM) associated with COVID-19 infection was at its peak during and immediately after the second wave of the pandemic in India during 2021. Many of the risk factors were implicated in the development of this deadly fungal infection, when there was a sudden surge of cases, especially who had a history of COVID-19 infection. Objectives: The objective of the study was to describe the characteristic magnetic resonance imaging (MRI) findings in invasive mucormycosis and to evaluate the extent and severity of invasive mucormycosis. Materials and Methods: A retrospective study was carried out for 4 months which included 60 patients who underwent MRI using a Siemens Avanto 1.5 Tesla scanner. During our study, 68 cases were selected based on clinicoradiological features suspected of ROCM. However, 8 patients were excluded on the basis of exclusion criteria as either there was no definitive evidence of COVID infection or were proven to be negative for mucormycosis on microbiological examination. Results: On the basis of the spectrum of MRI findings, post-COVID-19 related ROCM was broadly categorized into three stages. Out of total of 60 patients, the disease was localized to the nasal and paranasal sinus region (Stage I) in 7 patients (11.66%), extending to adjacent extrasinus orofacial soft tissue structures (Stage II) in 36 patients (60%), and intracranial extension of disease (Stage III) was seen in 17 patients (28.33%). Conclusion: In post-COVID-19 patients presenting with clinical features suspected of ROCM, MRI imaging helps in early diagnosis and staging/severity of ROCM, so that timely intervention can be planned to reduce mortality as well as morbidity.