A comparative study on the clinical profile of COVID-related and non-COVID-related acute invasive fungal rhino sinusitis.

PURPOSE: To compare the clinical profile of COVID-related and non-COVID-related rhino-orbito-cerebral invasive fungal disease. METHODS: We have compared the comorbidities, clinical features, course of the disease and outcome between COVID-related and non-COVID-related acute invasive fungal rhinosinusitis (AIFRS) of the rhino-orbito-cerebral form. RESULTS: HbA1c and blood sugar at the time of admission were significantly higher in the non-COVID group (P < 0.05). Duration of stay, and use of steroids were significantly higher among the COVID group (P < 0.05). The period of hospital stay was significantly higher in the COVID group. The overall survival in the COVID group was 67.57%. In the non-COVID group the overall survival was 61.90%.This study found that odds of surgical treatment was significantly lower among non-survivors (P < 0.05). Similarly patients who developed stages 3 & 4 of the disease had a lower survival rate (P < 0.05). CONCLUSION: Diabetes mellitus is a key risk factor for the development of AIFRS. Pre-existing, grossly uncontrolled DM was the predisposing factor in the non-COVID group. Deranged glucose profile associated with COVID illness and its treatment and immunological disturbances in a vulnerable population, contributed to the surge in cases of AIFRS in the COVID-19-related group. Patients who underwent combined medical and surgical treatment had a significantly better outcome following AIFRS.

Covid Assossiated Invasive Fungal Sinusitis.

Acute invasive fungal sinusitis is an aggressive infection affecting immunocomprosmised patients and carries a high mortality. Patients with Covid-pneumonia are at an increased risk of developing invasive pulmonary fungal infections probably due to their reduced immunological competence. Here, we review three cases of Covid-associated invasive fungal sinusitis.

Impact of education on health-beliefs in an emerging economy: Understanding urban vs. rural differences and the moderating effect of social capital.

In this paper, we assert the critical influence of education on health-beliefs among women from India, an emerging economy. We further examine the urban vs. rural differences and the role of social capital in shaping health-beliefs of women. Using nationally representative data of eligible women from India, we find education to have a positive influence on health-beliefs. We find this effect to be higher in rural regions. Further, we find social capital to negatively moderate the effect of education. Our findings stress the importance of education, especially in rural regions.

Studying the Prevalence, Species Distribution, and Detection of In vitro Production of Phospholipase from Candida Isolated from Cases of Invasive Candidiasis.

BACKGROUND AND AIM: Candida spp. have emerged as successful pathogens both in invasive and mucosal infections. C. albicans is the sixth cause of most common nosocomial infections according to studies by the Centers for Disease Control and Prevention. A shift toward non-albicans species has been reported. There is a dearth of knowledge regarding the virulence factors of Candida, especially from this part of India. The aim was to study the prevalence of Candida, speciate, and determine antifungal sensitivity along with the detection of in vitro production of phospholipases in 100 Candida isolates. MATERIALS AND METHODS: A total of 100 Candida isolates from various clinical specimens were studied (February 1, 2015-May 31, 2015; 4 months). Speciation was done by conventional methods and antifungal drugs fluconazole and voriconazole tested. Phospholipase activity (Pz value) was determined. RESULTS: Of the 100 Candida spp., 35% were C. albicans and 65% were nonalbicans Candida (NAC). Species spectrum was of the 100 isolates as follows: 35 were C. albicans, 17 Candida tropicalis, 6 Candida glabrata, 8 Candida guilliermondi, 1 Candida kefyr, 6 Candida krusei, 14 Candida parapsilosis, 2 Candida lusitaniae, and 1 Trichosporon and 10 Candida spp. (not speciated). Phospholipase production was seen in 81 (81%) of the total isolates. The majority (63%) of phospholipase producers were NAC. Among NAC spp., the maximum phospholipase activity was seen in C. tropicalis (30%) and C. parapsilosis (24%). Of these, 60% of Candida was from patients admitted to the hospital. Sensitivity rates of C. albicans for fluconazole and voriconazole were 89.5% and 90.5%, respectively. CONCLUSION: Increasing usage of devices, total parenteral nutrition, broad-spectrum antibiotics, chemotherapies, and transplantation are factors contributing to the increase of candidal infections. Recent studies underline the increasing frequency of infections by NAC. The present study showcases the increased prevalence as well as virulence of NAC. In addition, early detection of virulence factors by Candida is useful in clinical decision-making.

Keratomycosis: Etiology, Risk Factors and Differential Diagnosis- A Mini Review on Trichophyton spp.

Fungal keratitis is an infectious disease of the cornea. Lack of suspicion and delayed diagnosis herald the onset of complications often leading to permanent loss of vision or worse, enucleation. While a variety of pathogenic fungi especially non-dermatophyte molds associated with fungal keratitis have been identified, a comprehensive review identifying the Trichophyton spp. has not been completed. Trichophyton spp. is a rare but important entity implicated in fungal keratitis. Case reports from around the world designate it as a dangerous pathogen. Trichophyton spp. implicated in keratitis has not previously been reported and is considerably greater than suggested by incidence studies. Patient outcome is heavily reliant upon correct identification, timely intervention and effective treatment. Species identification, the risk factors associated with, and pathogenesis of keratitis will allow the development of improved therapies. This mini review provides a resource for clinicians and researchers to recognize Trichophyton spp. as a potent etiological agent capable of causing keratitis. It is no more a dermatophyte limited to infection of appendages.

Staphylococcus aureus: Screening for Nasal Carriers in a Community Setting with Special Reference to MRSA.

Introduction. Emergence of MRSA infections among previously healthy persons in community settings (without exposure to health care facilities) has been noted recently. MRSA infections are now classified as health care-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA) infections. Its colonization is an important risk factor for subsequent MRSA infection. Aims and Objectives. The aim was to screen patients and health care workers for staphylococcal carriage, identify risk factors for MRSA colonization, and determine the sensitivity pattern. Materials and Methods. A total of 200 subjects were screened for nasal carriage after obtaining verbal consent. These were both healthy subjects attending various outpatient departments and health care workers. Specimens were collected from the anterior nares using premoistened sterile cotton swabs and inoculated onto blood agar and mannitol salt agar and incubated at 37°C for 24-48 h. Results. Staphylococcus aureus colonisation was found to be 12% (n = 24). MRSA was identified in 5% (n = 10) which represents 41.66% of SA. A total of 10 strains of MRSA were isolated from 200 subjects, giving an overall positivity rate of 5%. Discussion. Staphylococcal colonization was found to be 12% (MRSA 5%). Fluoroquinolone resistance was remarkable whereas all strains were sensitive to vancomycin, teicoplanin, linezolid, quinupristin-dalfopristin.

Dengue and Typhoid Co-infection- Study from a Government Hospital in North Delhi.

BACKGROUND: Concurrent infection with two agents can result in an illness having overlapping symptoms creating a diagnostic dilemma for the treating physician. The symptoms of dengue may mimic other diseases such as leptospirosis, influenza A, Salmonella Typhi, Japanese encephalitis, chikungunya and malaria. There is paucity of data regarding dengue and typhoid co- infection both in the developed and developing countries. This study attempts to find the current co- infection rates in North Delhi. MATERIALS AND METHODS: This retrospective study was done between August and November 2013. Medical records of 659 patients exhibiting febrile illness who visited Kasturba Hospital were studied. Dengue specific IgM antibodies were detected by Dengue IgM antibody capture ELISA test. Serodiagnosis of Salmonella infection was conducted by Widal test in the hospital. RESULTS: Of the 659 febrile sera samples tested here, 141 (21.39%) tested positive for dengue. Of these 91 were females and 50 males. Of the dengue cases, eleven were co-infected with enteric fever (11/141= 7.8%). Maximum number of dengue positive cases seen in age group 0-10 y. Case Fatality Rate (CFR) was zero. Age groups of patients co-infected with dengue and typhoid were as follows: 0-10 y: 5, 11-20 y: 3, 21-30 y: 2, >60 y: 1. CONCLUSION: Co-infection should always be kept in mind while dealing with cases of dengue or enteric fever with or without atypical features. In order to reduce the burden of disease, along with improvement of sanitation and personal hygiene, emphasis should be given on vaccination against typhoid.

Age-related loss of noradrenergic neurons in the brains of triple transgenic mice.

Microscopic findings in Alzheimer's disease (AD) at autopsy include a wide cortical distribution of beta amyloid (Aß)-containing plaques and diminished numbers of pyramidal neurons in CA1 of hippocampus and tyrosine hydroxylase-positive (TH+) neurons in the locus coeruleus (LC). To better understand the neuropathology underlying cognitive decline in AD, we analyzed the AD-type neuropathology in brains of triple transgenic (3×Tg) mice harboring mutations for APP(swe), PS1(M146V), and tau(P301L). Histochemical and immunohistochemical staining and computerized stereology were carried out in age-matched young, early middle age, and late middle age 3×Tg mice. The 3×Tg mice showed an intracellular Aß deposition in subiculum and CA1 pyramidal neurons and an extracellular distribution of amyloid plaques specifically in the subiculum of hippocampal formation and in neocortical layer V. The 3×Tg mice also showed an age-related loss of TH+ neurons in LC, with a loss of 37% of these neurons at 15 months of age. There was no loss of CA1 neurons at any age examined. Reduced AD-type neuropathology in CA1 of 3×Tg mice suggests a possible neuroprotective role for high intracellular-to-extracellular ratios of insoluble Aß deposits. Understanding the neurobiology of this apparent neuroprotection could lead to an improved understanding of age-related cognitive function in general, and the development of novel strategies for the therapeutic management of AD patients.

Characterization and open windrow composting of MSW in Jodhpur City, Rajasthan, India.

Solid waste is sometimes not suitable for direct land application. Processing solid waste through composting converts it to a humus-containing organic material advantageous for agriculture/horticulture use. Major advantages of composting are stabilization of the wastes; substantially reduced C/N ratio and gas formation, and virtually elimination of odors and pathogens. Composting is accomplished under aerobic conditions developing temperatures of 55 degrees C or above. The windrow technique is simple and accomplished easily with standard equipments. The open windrow composting of municipal solid waste (MSW) in windrows was analyzed in this study for six weeks. The raw MSW was introduced to active composting without any source segregations. The moisture content of the MSW dropped from 58.88% to 48.06% and windrow attained a thermophillic temperature for about two weeks. It was observed that the pH, C/N ratio and temperature variations were comparable to that of traditional windrow composting. The peak temperature recorded was 68 degrees C and temperature remained above 60 degrees C for more than three weeks. The volume reduction was obtained by using one-cu.m. cage. The results indicate that the bulk composting could reduce by about 29% the total mass of the waste.

Antimicrobial resistance in bacterial isolates from a delhi hospital: one year outcomes.

Antimicrobial resistance and hospital acquired infections have become an important public health issue. Data on pathogen and antibiotic resistance is important for physicians, microbiologists and infection control officials but limited information on antibiotic resistance prevents pathogen specific therapy and propels antibiotic misuse. A retrospective review of bacterial isolation and antimicrobial susceptibility profiles in the in- and outpatients of a Delhi hospital between January 2009-December 2009 was performed. A total of 1772 pathogens causing bacterial infections were recorded during the study period January 2009-December 2009. The most frequently encountered bacterial pathogens were Escherichia coli (40.51%), Klebsiella spp. (14.84%) and Staphylococcus aureus (13.99%). We encountered high resistance to ciprofloxacin in Enterobactereaceae family, i.e., 32.5%. Aminoglycosides, once considered optimum for broad spectrum coverage of pathogens for almost all systemic infections, are now showing high rate of resistance as was noted in Acinetobacter sp. (57.14%) and Pseudomonas aeruginosa (69.2%). Antibiotic susceptibility results show a higher level of resistance to cotrimoxazole, cephalosporins and ciprofloxacin which are easily available, orally administered and cheaper and thus are considered a better option for the patients. This study provides insight into the problem of resistance in bacterial pathogens in Delhi. Our results demonstrated that, in general, isolates have high rates of resistance to antibiotics commonly used in developing countries. Guidelines for surveillance and prevention of nosocomial infections must be implemented in order to reduce the rate of hospital acquired infections.

Seroprevalence and trend of dengue cases admitted to a government hospital, delhi - 5-year study (2006-2010): a look into the age shift.

BACKGROUND: Diagnosis of dengue infection is easily and best accomplished by demonstration of specific IgM antibodies in blood. We analyzed retrospectively the dengue IgM seropositivity available for samples obtained over a period of 5 years (2006-2010) from patients with suspected dengue fever (DF)-like illness to investigate whether there was an overall increase in the dengue IgM prevalence over this period. METHODS: Blood samples were collected from patients with DF-like febrile illnesses attending the Pediatric, Medicine, and Fever clinics of a Government hospital, Delhi. A total of 8138 individuals (suspected dengue cases) obtained over 5 years were tested for dengue specific IgM antibodies. Year wise, month wise, and age wise data on geographic distribution and clinical manifestations were analyzed. RESULTS: Of the 8138 samples, 1600 (19.66%) were positive for dengue specific IgM. The year 2006 had the highest number of reported cases, 761 (46.23%). In our study, the age group most commonly affected of all 5 years was 11-20 years. Out of the total 1600 cases admitted to the hospital between 2006 and 2010, 279 (58.9%) had DF, 178 (37.6%) had dengue hemorrhagic fever, and 16 (3.38%) had dengue shock syndrome. We found a high burden of dengue in young children and late adolescents in both rural and urban communities at a magnitude greater than previously described. INTERPRETATION AND CONCLUSION: We observed an increase in the dengue positive cases every alternate year, thereby indicating a possible role of herd immunity in northern India. We did not find a steady increase in the number of cases over 5 years. We found an increase in the number of positive cases in children and young adolescents.

Trichophyton rubrum onychomycosis in an 8-week-old infant.

An 8-week-old infant presented with 7 weeks history of nail involvement and discoloration. Lesions started over the middle fingernail of right hand at 1 week of age, spreading over to other nails within 2 weeks. Only two nails of the feet were spared. On KOH examination, fungal hyphae were seen and culture showed growth of Trichophyton rubrum. The purpose is to report the earliest case of onychomycosis having multiple nail involvement of fingers and toes (18 nails).

Comparative anatomy of the locus coeruleus in humans and nonhuman primates.

The locus coeruleus (LC) is a dense cluster of neurons that projects axons throughout the neuroaxis and is located in the rostral pontine tegmentum extending from the level of the inferior colliculus to the motor nucleus of the trigeminal nerve. LC neurons are lost in the course of several neurodegenerative disorders, including Alzheimer's and Parkinson's diseases. In this study we used Nissl staining and tyrosine hydroxylase (TH) immunoreactivity to compare the human LC with that of closely related primate species, including great and lesser apes, and macaque monkeys. TH catalyzes the initial and rate-limiting step in catecholamine biosynthesis. The number of TH-immunoreactive (TH-ir) neurons was estimated in each species using stereologic methods. In the LC of humans the mean total number of TH-ir neurons was significantly higher compared to the other primates. Because the total number of TH-ir neurons in the LC was highly correlated with the species mean volume of the medulla oblongata, cerebellum, and neocortical gray matter, we conclude that much of the observed phylogenetic variation can be explained by anatomical scaling. Notably, the total number of LC neurons in humans was most closely predicted by the nonhuman allometric scaling relationship relative to medulla size, whereas the number of LC neurons in humans was considerably lower than predicted according to neocortex and cerebellum volume.

Effects of nicotine on depressive-like behavior and hippocampal volume of female WKY rats.

The observed high incidence of smoking amongst depressed individuals has led to the hypothesis of 'self medication" with nicotine in some of these patients. The inbred Wistar-Kyoto (WKY) rats exhibit depressive-like characteristics as evidenced by exaggerated immobility in the forced swim test (FST). One aim of this study was to investigate whether nicotine may have an antidepressant-like effect in these animals. Moreover, because of human postmortem studies indicating a reduction of the hippocampus volume in depressed patients, it was of interest to determine whether such an anatomical anomaly may also be manifested in WKY rats and whether it would be affected by chronic nicotine treatment. Adult female WKY and their control Wistar rats were administered nicotine consecutively (0.2 mg/kg, i.p., once or twice daily for 14 days) and their activity in an open field, as well as their immobility in FST were assessed either 15 min or 18 h after the last injection. Another set of animals was treated twice daily with 0.2 mg/kg nicotine for 14 days and sacrificed on day 15 for stereological evaluation of the hippocampal volume. When tested 15 min after the last injection, once or twice daily nicotine exacerbated the immobility in the FST in WKY rats only. When tested 18 h after the last injection, only twice daily nicotine treatment resulted in less immobility in the FST in WKY rats. Open field locomotor activity was not affected by any nicotine regimen. WKY rats had significantly less hippocampal volume (approximately 20%) than Wistar rats which was not altered by nicotine. These findings further validate the use of WKY rats as an animal model of human depression and signify the importance of inherent genetic differences in final behavioral outcome of nicotine.

Arsenic-induced cell death in liver and brain of experimental rats.

Arsenic is a well established human carcinogen and is ubiquitous in the environment. The present study demonstrates the effect of acute arsenic administration at three different doses in liver and brain of Wistar rats. Sodium arsenite was administered orally at doses of 6.3 mg/kg, 10.5 mg/kg and 12.6 mg/kg of body weight on the basis of a lethal dose 50% (LD50) for 24 hr. After administration of arsenites, liver and brain were analyzed for various parameters of oxidative stress, histopathological changes and caspase-3 activity. Glutathione levels were decreased significantly in the liver at all doses. In liver the following biochemical changes were observed, a significant lipid peroxidation and cytochrome-P450 induction along with significant decrease in catalase and superoxide dismutase was observed at 10.5 mg/kg and 12.6 mg/kg. The activity of glutathione peroxidase was increased significantly at all doses. In brain, no significant change was observed at 6.3 mg/kg. However, a significant increase in lipid peroxidation and glutathione peroxidase activity along with significant decrease in the activity of glutathione, catalase and superoxide dismutase was observed at 10.5 mg/kg and 12.6 mg/kg. The activity of glutathione-S-transferase was decreased significantly in both liver and brain at 10.5 and 12.6 mg/kg. No significant alteration in the activity of glucose-6-phosphate dehydrogenase and glutathione reductase was observed in either liver or brain at any dose. Dose-dependent histopathological changes, observed in both liver and brain are also described. A significant increase in caspase-3 activity was observed at all doses in liver and at 10.5 and 12.6 mg/kg in brain. Sodium arsenite caused DNA cleavage into fragments and manifested as "DNA laddering", a hallmark of apoptosis.

Arsenic induced apoptosis in rat liver following repeated 60 days exposure.

BACKGROUND: Accumulation of the wide spread environmental toxin arsenic in liver results in hepatotoxcity. Exposure to arsenite and other arsenicals has been previously shown to induce apoptosis in certain tumor cell lines at low (1-3 microM) concentration. AIM: The present study was focused to elucidate the role of free radicals in arsenic toxicity and to investigate the nature of in vivo sodium arsenite induced cell death in liver. METHODS: Male wistar rats were exposed to arsenite at three different doses of 0.05, 2.5 and 5mg/l for 60 days. Oxidative stress in liver was measured by estimating pro-oxidant and antioxidant activity in liver. Histopathological examination of liver was carried out by light and transmission electron microscopy. Analysis of DNA fragmentation by gel electrophoresis was used to identify apoptosis after the exposure. Terminal deoxy-nucleotidyl transferase mediated dUTP Nick end-labeling (TUNEL) assay was used to qualify and quantify apoptosis. RESULTS: A significant increase in cytochrome-P450 and lipid peroxidation accompanied with a significant alteration in the activity of many of the antioxidants was observed, all suggestive of arsenic induced oxidative stress. Histopathological examination under light and transmission electron microscope suggested a combination of ongoing necrosis and apoptosis. DNA-TUNEL showed an increase in apoptotic cells in liver. Agarose gel electrophoresis of DNA of hepatocytes resulted in a characteristic ladder pattern. CONCLUSION: Chronic arsenic administration induces a specific pattern of apoptosis called post-mitotic apoptosis.

Dimethoate-induced effects on antioxidant status of liver and brain of rats following subchronic exposure.

Dimethoate, an organophosphate pesticide, is used in controlling the pests of a variety of crops. The study was carried out to understand the role of dimethoate in inducing oxidative stress leading to generation of free radicals and alterations in antioxidant enzymes and scavengers of oxygen free radicals. The effects of subchronic exposure of dimethoate in the production of oxidative stress were evaluated in male Wistar rats in the present study. Dimethoate was administered orally at doses 0.6, 6, and 30 mg/kg for 30 days in these rats. The results indicated an increase in levels of hepatic Cytochrome P450, lipid peroxidation, catalase, superoxide dismutase, glutathione peroxidase and glutathione reductase in liver and brain at doses 6 and 30 mg/kg. There were no significant changes in the level of glucose-6-phosphate dehydrogenase activity except in liver at 30 mg/kg. A decrease in glutathione was observed at 30 and 6 mg/kg in both liver and brain. Glutathione-S-transferase increased at 30 and 6 mg/kg in liver and 30 mg/kg in brain. Erythrocyte acetylcholinesterase was inhibited at 30 and 6 mg/kg doses. Dose-dependent histopathological changes were seen in both liver and brain. This study concludes that oxidative stress due to dimethoate may be ascribed to induction of Cytochrome P450, inhibition of AChE and disturbance in activities of GSH and GST enzymes causing lipid peroxidation and histological and electron microscopic changes in liver and brain.

Effects of acute dimethoate administration on antioxidant status of liver and brain of experimental rats.

Organophosphorus compounds may induce oxidative stress leading to generation of free radicals and alterations in antioxidant and scavengers of oxygen free radicals. The present study demonstrates effect of acute exposure of dimethoate in causation of oxidative stress in male Wistar rats. Dimethoate was administered orally at doses 45, 75 and 90 mg/kg of body weight on the basis of LD(50) for 24 h. After administration of doses, the liver and brain homogenates were analyzed for various parameters of oxidative stress. The results indicated an increase in hepatic cytochrome P450, lipid peroxidation, catalase, superoxide dismutase, glutathione peroxidase, glutathione reductase in liver and brain at 90 and 75 mg/kg doses. There were no significant changes in the levels of glucose-6-phosphate dehydrogenase activity in both liver and brain. Similarly, there were no significant changes in hepatic glutathione and glutathione-S-transferase activities. However, there was a significant increase in glutathione and glutathione-S-transferase in brain at 90 mg/kg dose only. Erythrocyte acetylcholinesterase was inhibited at all doses used. Dose-dependent histopathological changes, observed in both liver and brain, are also described.