Risk Factors Associated with Mortality in Patients with Mucormycosis Post Severe Acute Respiratory Syndrome Coronavirus-2 (Sars-Cov-2) Infection.

To study the potential risk factors associated with mortality in patients with mucormycosis. A retrospective study of 490 patients with diagnosis of sinonasal mucormycosis was done. They were divided in two groups-Group A included 87 patients that expired during the study period and Group B included 403 control patients. All the demographic, clinical and outcome parameters were collected from the patient's record files and noted in a structured case proforma and were analysed. During the mean hospital stay of 22 ± 6 days, 17.7% patients expired during the treatment course. Multiple risk factors like uncontrolled diabetes, dyselectrolytemia, underlying renal disease and extensive nature of the disease involving orbit, intracranium and with pulmonary dissemination, all were associated with high mortality in Mucormycosis. Early recognition and appropriate management of the secondary factors can grossly reduce the risk of mortality in patients with mucormycosis.

Imaging the extracellular matrix in live tissues and organisms with a glycan-binding fluorophore.

All multicellular systems produce and dynamically regulate extracellular matrices (ECM) that play important roles in both biochemical and mechanical signaling. Though the spatial arrangement of these extracellular assemblies is critical to their biological functions, visualization of ECM structure is challenging, in part because the biomolecules that compose the ECM are difficult to fluorescently label individually and collectively. Here, we present a cell-impermeable small molecule fluorophore, termed Rhobo6, that turns on and red shifts upon reversible binding to glycans. Given that most ECM components are densely glycosylated, the dye enables wash-free visualization of ECM, in systems ranging from in vitro substrates to in vivo mouse mammary tumors. Relative to existing techniques, Rhobo6 provides a broad substrate profile, superior tissue penetration, nonperturbative labeling, and negligible photobleaching. This work establishes a straightforward method for imaging the distribution of ECM in live tissues and organisms, lowering barriers for investigation of extracellular biology.

Nasopharyngeal Foreign Body with Unusual Presentation.

Introduction: An unusual nasopharyngeal foreign body in a very young child with no clinical symptoms is a rare case presentation. Case Report: A nine-month-old child presented with a suspected history of foreign body ingestion without any clue to the parents about the nature of the foreign body. X-ray of the nasopharynx revealed a sharp unusual metallic "Louis Vuitton" shoe logo that the child had accidentally inserted into the nasopharynx via the oral cavity while playing. Foreign body was removed under general anesthesia without complications. Conclusion: X-ray nasopharynx should be included in the examination of a suspected case of foreign body ingestion, as an unusual shape of foreign body can even produce no clinical symptoms but still pose a potential life threat due to its dislodgement into the airway if missed or delayed.

Diabetic Retinopathy: Clinical Features, Risk Factors, and Treatment Options.

Diabetic retinopathy is a common complication of diabetes that affects the eyes and can lead to severe vision loss or blindness if left untreated. Chronic hyperglycemia destroys the blood vessels in the retina, resulting in diabetic retinopathy. The damage can lead to leakage of fluid and blood into the retina, causing edema, hemorrhages, and ischemia. A thorough evaluation by an ophthalmologist is necessary to determine the most appropriate course of treatment for each patient with diabetic retinopathy. The article discusses various surgical treatment options for diabetic retinopathy, including vitrectomy, scleral buckling, epiretinal membrane peeling, retinal detachment repair, and the risk factors of diabetic retinopathy. These surgical techniques can help to address the underlying causes of vision loss and prevent further complications from developing or worsening. To avoid complications and maintain vision, this review emphasizes the significance of early detection and treatment of diabetic retinopathy. Patients with diabetic retinopathy can improve their eyesight and quality of life with the help of some surgical treatments. The article also highlights some case studies in the field of diabetic retinopathy.

Isolated Frontal Sinus Mucormycosis Post Covid 19-external Approaches Revisited!

Background: Isolated frontal sinus involvement in mucormycosis is seen very infrequently. Recent technological advances including image guided navigation and angled endoscopes have shifted paradigm towards minimally invasive surgeries. Open approaches are still relevant for the disease of frontal sinus with lateral extension where effective clearance cannot be obtained if approached endoscopically. Objectives: The objective of this study was to describe the presentation and management of patients of mucormycosis with isolated frontal sinus involvement with help of external approaches. Materials and methods: The available records of the patients were retrieved and analysed. The literature, the associated contributory clinical features and management techniques were reviewed. Results: 4 patients presented with isolated frontal sinus mucor involvement. 3 out of 4 patients had history of diabetes mellitus (75%). All patients had history of covid-19 infection (100%). 3 out of 4 patients had unilateral frontal sinus involvement and were operated by Lynch Howarth approach. Mean age of presentation was 46 years with male predominance. Bicoronal approach was used in one case with bilateral involvement. Conclusion: Although conservative endoscopic surgeries are preferred nowadays for frontal sinus clearance but the extensive bony destruction with lateral extension in our series of patients with isolated frontal sinus mucormycosis warranted the need for open procedures.

Secondary Cutaneous Mucormycosis - Retrospective Analysis From Tertiary Care Hospitall.

Background: Covid-19 infection increases the risk of opportunistic infections like mucormycosis. Cutaneous mucormycosis can occur primarily by direct inoculation or secondary to involvement of the underlying structures. Cutaneous manifestations include tender, erythematous, indurated lesions and necrotic plaques. As the disease evolves, cutaneous features manifest progressively. Objectives: To study the manifestations of the cutaneous signs of sinonasal mucormycosis and management of such cases based on severity of involvement. Materials and methods: A retrospective analysis of 21 patients with diagnosis of cutaneous mucormycosis secondary to sinonasal involvement was done with assessment of their skin lesion, area involved and their clinical stage being noted at the time of admission and after 24 h. Treatment consisted of combination of surgical debridement, daily dressing and liposomal amphotericin B. Observations and Results: Out of total 21 patients, there were 10 males and 11 females. Among risk factors, 14 cases had history of covid 19 infection, 5 had history of steroid intake, 6 had history of ICU stay and all had deranged blood sugar levels. Among disease prognosis, excellent outcomes appeared in stage I and stage III showed worst outcome. Conclusion: Since initial clinical presentation is similar to cellulitis and other soft-tissue infections, early recognition is difficult. In this cohort, the prognosis of secondary cutaneous mucormycosis remained poor, especially in ICU patients and those with numerous predisposing factors. Such patients presented in late stages of the disease and mortality rate was very high in such group.

Comparative Study of Inlay and Overlay Cartilage Perichondrium Composite Graft Myringoplasty.

To compare results of inlay and overlay cartilage-perichondrium composite graft myringoplasty. The present study was conducted in the department of otorhinolaryngology, Pt. B. D. Sharma PGIMS, Rohtak. The study was conducted on 40 patients of either sex in age group of 15-50 years having unilateral or bilateral inactive (mucosal) chronic otitis media with dry ear over a period of at least 4 weeks without use of topical or systemic antibiotics after obtaining their informed and written consent. Mean age in group I was 25.25 ± 7.27 years and in group II was 25.95 ± 9.06 years. Maximum number of patients in both groups were in the age group 15-24 years. Out of the total patients, 60% were males and 40% were females. At 6 months post operatively, 95% cases in group I had successful graft take-up compared to 85% cases in group II. However, at long term follow up for 24 months, graft success rate was statistically significant in group I. In group I, 100% graft uptake was seen in large size perforation of 4 and 5 mm along with 2 mm as compared to group II, with 100% graft uptake for only small size perforation of 2 mm. The mean hearing threshold gain was 16.50 ± 5.52 dB in group I as compared to 13.03 ± 6.44 dB in group II. Mean postoperative improvement in air bone (AB) gap of 16.50 ± 5.52 dB was seen in group I as compared to 13.07 ± 6.44 dB seen in group II. The graft take up rate was found to be better in long term with inlay cartilage- perichondrium composite graft myringoplasty technique compared to over lay technique with both the groups showing significant hearing improvement post-operatively. This high success rate for graft uptake and ease to perform under local anaesthesia makes in-lay cartilage perichondrium composite graft myringoplasty technique relatively optimal to use for office based myringoplasty. Supplementary Information: The online version contains supplementary material available at 10.1007/s12070-023-03487-w.

Normocalcemic Parathyroid Adenoma with Brown's Tumor Maxilla: A Rare Case.

Introduction: Primary hyperparathyroidism due to parathyroid adenoma commonly causes raised serum calcium and focal giant cell lytic lesions in bones known as Brown's tumors. It is more common in females in the post-menopausal age group. Case Report: We report a case of a 29-year-old female patient with Brown's tumor maxilla in a clinical setting of normocalcemic primary hyperparathyroidism. The patient presented to us with facial and palatal swelling for which FNAC was done. Cytology revealed hemosiderin-laden macrophages suspicious for Brown's tumor. On further imaging studies such as CT Neck, Tc99 Sestamibi scan, and other biochemical tests like parathyroid hormone assay and serum calcium level, the diagnosis of a hyperfunctioning parathyroid gland with normal calcium level was made. Parathyroidectomy was performed and parathyroid adenoma came out to be the primary pathology. On post-operative follow up there was regression of the swelling on the face and palate relieving the patient symptomatically. Conclusion: The diagnostic suspicion of primary hyperparathyroidism should be kept in mind whenever a young female presents with suspected Brown's tumor, even with normal serum calcium levels, for appropriate management. Ours was a highly uncommon case that was a diagnostic challenge and had a successful treatment outcome. Very few such cases have been reported in the literature to date to the best of our knowledge.

Lipid Expansion Microscopy.

Strategies to visualize cellular membranes with light microscopy are restricted by the diffraction limit of light, which far exceeds the dimensions of lipid bilayers. Here, we describe a method for super-resolution imaging of metabolically labeled phospholipids within cellular membranes. Guided by the principles of expansion microscopy, we develop an all-small molecule approach that enables direct chemical anchoring of bioorthogonally labeled phospholipids into a hydrogel network and is capable of super-resolution imaging of cellular membranes. We apply this method, termed lipid expansion microscopy (LExM), to visualize organelle membranes with precision, including a unique class of membrane-bound structures known as nuclear invaginations. Compatible with standard confocal microscopes, LExM will be widely applicable for super-resolution imaging of phospholipids and cellular membranes in numerous physiological contexts.

Non-Invasive characterisation of renal stones using dual energy CT: A method to differentiate calcium stones.

BACKGROUND: Non-invasive DECT based characterization of renal stones using their effective atomic number (Zeff) and the electron density (ρe) in patients. AIM: This paper aims to develop a method for in-vivo characterization of renal stone. Differentiation of renal stones in-vivo especially sub types of calcium stones have very important advantage for better judgement of treatment modality. MATERIALS AND METHODS: 50 extracted renal stones were scanned ex-vivo using dual energy CT scanner. A method was developed to characterize these renal stones using effective atomic number and electron density obtained from dual energy CT data. The method and formulation developed in ex-vivo experiments was applied in in-vivo study of 50 randomly selected patients of renal stones who underwent dual energy CT scan. RESULTS: The developed method was able to characterize Calcium Oxalate Monohydrate (COM) and the combination of COM and Calcium Oxalate Dihydrate (COD) stones non-invasively in patients with a sensitivity of 81% and 83%respectively. The method was also capable of differentiating Uric, Cystine and mixed stones with the sensitivity of 100, 100 and 85.71% respectively. CONCLUSION: The developed dual energy CT based method was capable of differentiating sub types of calcium stones which is not differentiable on single energy or dual energy CT images.

2,7-Diaminobenzopyrylium Dyes Are Live-Cell Mitochondrial Stains.

Small-molecule fluorescent stains enable the imaging of cellular structures without the need for genetic manipulation. Here, we introduce 2,7-diaminobenzopyrylium (DAB) dyes as live-cell mitochondrial stains excited with violet light. This amalgam of the coumarin and rhodamine fluorophore structures yields dyes with high photostability and tunable spectral properties.

Melding Synthetic Molecules and Genetically Encoded Proteins to Forge New Tools for Neuroscience.

Unraveling the complexity of the brain requires sophisticated methods to probe and perturb neurobiological processes with high spatiotemporal control. The field of chemical biology has produced general strategies to combine the molecular specificity of small-molecule tools with the cellular specificity of genetically encoded reagents. Here, we survey the application, refinement, and extension of these hybrid small-molecule:protein methods to problems in neuroscience, which yields powerful reagents to precisely measure and manipulate neural systems.

Biphenotypic Sinonasal Sarcoma with Intracranial Extension - A Case Report with Review of Literature.

Rationale: Biphenotypic sinonasal sarcoma is a rare malignant tumour exclusively involving the sinonasal cavity. These tumours have variable and atypical presentations. Early approach and correct treatment modalities are key factors in the management of such cases. Patient Concern: A 48-year-old male patient presented with left-sided nasal obstruction and intermittent nasal bleeding for one year. Diagnosis: Biphenotypic sinonasal sarcoma confirmed on histopathological examination and immunohistochemistry. Treatment: The patient underwent surgical excision with left lateral rhinotomy and bifrontal craniotomy with skull base repair. The patient also received postoperative radiotherapy. Outcome: The patient is on regular follow-up with no similar complaints. Take-Away Lesson: Treating team should keep the diagnosis of biphenotypic sinonasal sarcoma in mind while investigating a patient with nasal mass. Surgical management is the treatment of choice, due to its local aggressive nature and proximity to the brain and eyes. Postoperative radiotherapy is vital to prevent tumour recurrence.

Trace Metal Residues in Marine Mussels: A Global Survey.

Pressures from anthropogenic activities are causing degradation of estuarine and coastal ecosystems around the world. Trace metals are key pollutants that are released and can partition in a range of environmental compartments, to be ultimately accumulated in exposed biota. The level of pressure varies with locations and the range and intensity of anthropogenic activities. The present study measured residues of trace metals in Mytilus mussel species collected from a range of locations around the world in areas experiencing a gradient of anthropogenic pressures that we classified as low, moderate, or high impact. The data showed no grouping/impact level when sampling sites in all countries were incorporated in the analysis, but there was significant clustering/impact level for most countries. Overall, high-impact areas were characterized by elevated concentrations of zinc, lead, nickel, and arsenic, whereas copper and silver were detected at higher concentrations in medium-impact areas. Finally, whereas most metals were found at lower concentrations in areas classified as low impact, cadmium was typically elevated in these areas. The present study provides a unique snapshot of worldwide levels of coastal metal contamination through the use of Mytilus species, a well-established marine biomonitoring tool. Environ Toxicol Chem 2021;40:3434-3440. © 2021 SETAC.

Science-society-policy interface for microplastic and nanoplastic: Environmental and biomedical aspects.

The global concern over the possible consequences of the downsizing of plastic to microplastics (MPs) and nano plastics (NPs) needs to be addressed with a new conceptual framework. The transformation of plastics to MPs and NPs can be discussed in terms of fundamental physics principles applicable to micro and nanophase matter and colloidal science principles. Further, accurate and reliable detection and characterization of MPs and NPs are crucial for an extensive understanding of their environmental and ecological impacts. The other decisive factor that can classify MPs and NPs as hazardous to existing nanomaterials is discussing the cytotoxicity study on human cell lines. The human health risk assessment that might arise from the ingestion of MPs and NPs can be addressed about contrast agents used for medical imaging. However, the lack of standard analytical techniques for MPs and NPs measurement is an emerging challenge for analytical scientists due to their complex physicochemical properties, especially in environmental samples. This review article navigates readers through the point of origin of MPs and NPs and their interdisciplinary aspects. Biomedical applications of plastics and concerns over the toxicity of MPs and NPs are further analyzed. Moreover, the analytical challenges of MPs and NPs have been discussed with critical inputs. Finally, the worldwide efforts being made for creating a common platform of discussion on a different aspect of plastic pollution were taken into account.

Diacetylene-Based Colorimetric Radiation Sensors for the Detection and Measurement of γ Radiation during Blood Irradiation.

Blood and its cellular components are irradiated by ionizing radiation before transfusion to prevent the proliferation of viable T lymphocytes which cause transfusion associated-graft versus host disease. The immunodeficient patients undergoing chemotherapy for various malignancies are at risk of this disease. The international guidelines for blood transfusion recommend a minimum radiation exposure of 25 Gray (Gy) to the midplane of the blood bag, while a minimum dose of 15 Gy and a maximum dose of 50 Gy should be given to each portion of the blood bag. Therefore, precise dosimetry of the blood irradiator is essential to ensure the adequate irradiation of the blood components. The paper presents the fabrication of diacetylene-based colorimetric film dosimeters for the verification of irradiated doses. The diacetylene analogues are synthesized by tailoring them with different amide-based headgroups followed by their coating to develop colorimetric film dosimeters. Among all the synthesized diacetylene analogues, aminofluorene-substituted diacetylene exhibits the most significant color transition from white to blue color at a minimum γ radiation dose of 5 Gy. The quantitative study of color change is performed by the digitization of the scanned images of film dosimeters. The digital image processing of the developed film dosimeters facilitates rapid dose measurement which enables their facile implementation and promising application in routine blood irradiator dosimetry.

Quantification of narrow band UVB radiation doses in phototherapy using diacetylene based film dosimeters.

Narrow band ultraviolet B (NB UVB) radiation doses are administered during phototherapy for various dermatological ailments. Precise quantification of these doses is vital because the absorbed irradiation can cause adverse photochemical reactions which can lead to potential phototherapeutic side effects. The paper presents development of diacetylene based dosimeter for the determination of therapeutic NB UVB doses during phototherapy. The amide terminated diacetylene analogues have been synthesized by tailoring them with different functional groups. The synthesized diacetylene monomers have been introduced in a polyvinyl alcohol binder solution to obtain a film dosimeter. The influence of different headgroups on the colorimetric response to UV radiation has been studied. Among all the synthesized diacetylene analogues, the naphthylamine substituted diacetylene exhibited excellent color transition from white to blue color at 100 mJ cm-2 NB UVB radiation dose. The developed amide films can be easily pasted on multiple sites of the patient's skin to monitor doses during phototherapy simultaneously at different anatomical regions. The digital image processing of the scanned images of the irradiated films facilitates rapid dose measurement which enables facile implementation of the developed film dosimeters and promising application in routine clinical dosimetry.

Feasibility of the use of different types of enzymatically treated cellulosic fibres for polylactic acid (PLA) recycling.

In the present study, the potential use of cellulosic microfibers (CMFs) extracted from hemp fiber (HF) and pulp and paper solid waste (mixed sludge (MS), deinked sludge (DS)) as a reinforcing agent in novel bio composite materials produced from recycled Polylactic acid (rPLA) was investigated. CMFs were extracted and treated using physicochemical method followed by enzymatic treatment with laccase and cellulase. The effects of CMFs concentrations (1.5, 3 and 6% w/w) and fiber size (75 µm-1.7 mm) on the mechanical properties (impact and tensile) and biodegradability of the biocomposite samples were investigated. A modified interfacial adhesion between rPLA matrix and the three fibers used, was clearly observed through mechanical tests due to alkali and enzymatic treatments. The use of different types of enzymatically treated cellulosic fibers for polylactic acid (PLA) recycling was assessed by Scaning electron microscopy (SEM), X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR). The combined physicochemical and enzymatic treatments led to a considerable size reduction of the cellulosic fibers (HF, MS and DS) resulting in the enhanced interfacial adhesion between rPLA matrix and fibers. The biocomposite obtained with rPLA with HF gave the most favorable values for Young's modulus (324.53 ± 3.10 MPa, p-value 0.03), impact strength (27.61 ± 2.94 kJ/m2, p-value 0.01) and biodegradation rate (1.97%).

Right-sided versus left-sided percutaneous transhepatic biliary drainage in the management of malignant biliary obstruction: a randomized controlled study.

AIM: To compare the technical difficulty, safety, radiation exposure and success rates between right-sided and left-sided percutaneous transhepatic biliary drainage (RPTBD and LPTBD) in patients with malignant biliary obstruction (MBO). MATERIALS AND METHODS: Fifty patients (28 males, 22 females; mean age 51.78 years) with MBO were randomized to undergo either RPTBD or LPTBD during the study period between June 2016 and May 2018. The procedure time, fluoroscopy time, radiation doses to the operators and patients, technical success, clinical success, complications and effect on quality of life were evaluated and compared between the two groups. RESULTS: Twenty-five patients were included in each group. The technical success was 100% in both groups. There was no significant difference between RPTBD and LPTBD groups in terms of major complications [4% and 12%, respectively; p = 0.297] and minor complications [40% and 32%, respectively; p = 0.597]. Further, the average procedure time (37.80 ± 13.07 min vs 41.04 ± 14.94 min), fluoroscopy time (5.88 ± 4.2 min vs 5.97 ± 3.8 min), radiation doses to the operator (136.84 ± 106.67 µSv vs 130.40 ± 106.46 µSv) and to the patient (8.23 ± 5.80 Gycm2 vs 11.74 ± 11.28 Gycm2) were not significantly different between the groups. Clinical success was achieved in 21 patients (84%) of RPTBD group and 17 patients (68%) of LPTBD group with no significant difference (p = 0.416) between them. CONCLUSION: There was no significant difference between RPTBD and LPTBD with reference to the technique, safety, radiation dose, success rates and impact on quality of life suggesting no laterality advantage for biliary drainage in cases of MBO.

A low-cost graphitized sand filter to deliver MC-LR-free potable water: Water treatment plants and household perspective.

Scale-up feasibility of the graphitized sand filter (GS1) for Microcystin-LR (MC-LR) removal and its impact on other water pollutants (WPs) was assessed through a mass-balance study, using a laboratory-based drinking water treatment plant (DWTP) micromodel named: SAP-1©. The treatment system comprised: raw water tank, pre-oxidation tank (oxidant: potassium permanganate), followed by a coagulation/flocculation tank (alum supplemented), sedimentation tank, filtration module and finally disinfection tank (dosed with hypochlorite solution). Two filter modules (FMs) were studied: a) FM1: graphitized-sand media + sand media = ½ GS1 + ½ sand and b) FM2: ½ sand + ½ sand. The MC-LR removal study (initial concentration: 50 µg/L) was performed for two varieties of MC-LR source: a) commercial MC-LR, and b) algal-biomass released MC-LR. Along with MC-LR, other WPs were also evaluated including metal ions (Fe2+ and Cu2+), total coliform, turbidity, ammonia-N and dissolved organic carbon. The removal efficiency of these WPs was determined for each treatment unit (as it passed). FM1 was able to reduce the inflow residual of MC-LR (coming from the preceding unit: sedimentation unit) from 12.1 µg/L and 25.4 µg/L (for commercial and algal-cell MC-LR source, respectively) to <0.61 µg/L and hence successfully complying the WHO guidelines (<1 µg/L). The protein phosphatase 1A (PP1A) toxicity assay confirmed a much safer and more toxic-free filtrate (by 40%-50%) for FM1 as compared to the filtrate obtained from FM2. The techno-economic evaluation showed that for an annual household filter application, 160 CAD needs to be spent on one GS1-based filter unit as compared to over 6000 CAD (equivalent price) for the conventional sand-based filter to provide MC-LR-free water. The present study demonstrates the feasibility of the utilization of these units in household filtration systems.