Epidemiology, clinical presentation and management of COVID-19 associated mucormycosis: A single centre experience from Pune, Western India.

BACKGROUND: The second COVID-19 wave in India has been associated with an unprecedented increase in cases of COVID-19 associated mucormycosis (CAM), mainly Rhino-orbito-cerebral mucormycosis (ROCM). METHODS: This retrospective cohort study was conducted at Noble hospital and Research Centre (NHRC), Pune, India, between 1 April, 2020, and 1 August, 2021, to identify CAM patients and assess their management outcomes. The primary endpoint was incidence of all-cause mortality due to CAM. RESULTS: 59 patients were diagnosed with CAM. Median duration from the first positive COVID-19 RT PCR test to diagnosis of CAM was 17 (IQR: 12,22) days. 90% patients were diabetic with 89% having uncontrolled sugar level (HbA1c >7%). All patients were prescribed steroids during treatment for COVID-19. 56% patients were prescribed steroids for non-hypoxemic, mild COVID-19 (irrational steroid therapy), while in 9%, steroids were prescribed in inappropriately high dose. Patients were treated with a combination of surgical debridement (94%), intravenous liposomal Amphotericin B (91%) and concomitant oral Posaconazole (95.4%). 74.6% patients were discharged after clinical and radiologic recovery while 25.4% died. On relative risk analysis, COVID-19 CT severity index ≥18 (p = .017), presence of orbital symptoms (p = .002), presence of diabetic ketoacidosis (p = .011) and cerebral involvement (p = .0004) were associated with increased risk of death. CONCLUSIONS: CAM is a rapidly progressive, angio-invasive, opportunistic fungal infection, which is fatal if left untreated. Combination of surgical debridement and antifungal therapy leads to clinical and radiologic improvement in majority of cases.

Oral-Ocular Synkinesis in a 21-Year Old Female Head Trauma Patient Following Facial Nerve Decompression Surgery.

ABSTRACT: Facial synkinesis can happen as a negative event following the recovery of facial nerve paralysis. In this case report, five months after right facial nerve decompression surgery following right sided head trauma, a 21-year-old female patient developed oral-ocular synkinesis. During her attempt to voluntarily smile, she experienced uncontrolled winking of her right eye. Exercise therapy was used as a treatment modality which largely improved her facial nerve function and decreased her synkinesis. As a treatment modality, exercise therapy was used which saw a great improvement in both her facial nerve function and decreased her synkinesis.

Reactions of Arylcarbenes with Lewis Acids.

The reactions of the three triplet ground state arylcarbenes diphenylcarbene 1, fluorenylidene 2, and dibenzocycloheptadienylidene 3 with the Lewis acids H2 O, ICF3 , and BF3 were studied under the conditions of matrix isolation. H2 O was selected as typical hydrogen bond donor, ICF3 as halogen bond donor, and BF3 as strong Lewis acid. H2 O forms hydrogen-bonded complexes of the singlet carbenes with 1 and 2, but not with 3. This is rationalized by the larger singlet-triplet gap of 3, which does not allow to stabilize the singlet state below the triplet state by hydrogen bonding. With ICF3 , both 1 and 3 form halogen-bonded complexes of the singlet states of the carbenes. This indicates that halogen bonding stabilizes singlet carbenes more than hydrogen bonding. Carbene 2 reacts differently from 1 and 3 by forming an iodonium ylide, thus avoiding antiaromatic destabilization of the fluorenyl unit. With BF3 , all three carbenes form zwitterionic Lewis acid/base complexes.

Activation of Molecular Hydrogen by Arylcarbenes.

The hydrogenation reactions of diphenylcarbene 1, fluorenylidene 2, and dibenzocycloheptadienylidene 3 were investigated in solid H2 and D2 matrices and in H2 - and D2 -doped argon matrices at cryogenic temperatures. The reactivity of the carbenes towards H2 increases in the order 1<3<2. Whereas 1 is stable in solid H2 , 2 and 3 react fast under the same conditions via quantum chemical tunneling. In D2 both 1 and 3 are stable, whereas 2 slowly reacts. The different reactivity of the three carbenes is rationalized in terms of differing carbene stabilization energies.

Matrix Isolation Infrared and Ab Initio Study of the Interaction of N-Heterocyclic Carbene with Water and Methanol: A Case Study of a Strong Hydrogen Bond.

This study reports, for the first time, the experimental study of the hydrogen-bonded complexes of H2O and MeOH with 1,3-dimethylimidazol-2-ylidene, which is a dimethyl-substituted N-heterocyclic carbene, using matrix isolation infrared spectroscopy. The hydrogen bond was found to be established between the carbene carbon and the hydrogen in the O-H group of H2O or MeOH. The hydrogen-bonded complexes of N-heterocyclic carbenes are significantly stronger than many conventional hydrogen-bonded systems, as is evidenced by the large red shifts observed in the infrared frequencies of complexed H2O and MeOH. The experimental results were corroborated by computations performed at MP2 and M06-2X levels of theory, using 6-311++G(d,p) and aug-cc-pVDZ basis sets, which indicated large interaction energies (∼9 kcal mol-1) for these complexes. Single-point calculations at the CCSD level of theory were also performed. Atoms-in-molecules (AIM), NBO, and LMOEDA analyses were also performed to understand the nature of the intermolecular interactions in these complexes. The dominant interaction was the electron delocalization from the carbene carbon to the σ* orbital of O-H of H2O or MeOH.

Enhanced electron transfer kinetics through hybrid graphene-carbon nanotube films.

We report the first study of the electrochemical reactivity of a graphenated carbon nanotube (g-CNT) film. The electron transfer kinetics of the ferri-ferrocyanide couple were examined for a g-CNT film and compared to the kinetics to standard carbon nanotubes (CNTs). The g-CNT film exhibited much higher catalytic activity, with a heterogeneous electron-transfer rate constant, k0, approximately two orders of magnitude higher than for standard CNTs. Scanning electron microscopy and Raman spectroscopy were used to correlate the higher electron transfer kinetics with the higher edge-density of the g-CNT film.

Effect of porosity variation on the electrochemical behavior of vertically aligned multi-walled carbon nanotubes.

Electrochemical charge storage characteristics of vertically aligned multi-walled carbon nanotubes (MWCNTs) as a function of varying diameter and spacing are reported. It was observed that the specific capacitance of the MWCNTs increased as both diameter and inter-tube spacing decreased. The MWCNT films with 229 nm inter-MWCNT spacing exhibited specific capacitance of 228 F/g versus 70 F/g for 506 nm spacing, when tested in a non-aqueous electrolyte. Further, a trend in specific capacitance versus pore size is proposed. Coupled with previously reported trends observed in the sub-10 nm pore size regime, this is expected to offer better understanding of electrochemical behavior of porous carbon materials over a wide range of pore sizes.

A problem of self-isolation in Japan: The relationship between self-isolation and COVID-19 community case.

Background: The Japanese government advised mild or asymptomatic coronavirus disease-2019 (COVID-19) cases to self-isolate at home, while more severe individuals were treated at health posts. Poor compliance with self-isolation could be a potential reason for the new outbreak. Our study aimed to find out the correlation between the rising new cases of COVID-19 and home-based patients in Japan. Methods: A secondary data analysis study was conducted with the data from COVID-19- involved databases collected from Johns Hopkins University, Japanese Ministry of Health, Labour and Welfare, and Community Mobility Reports of Google. New community cases, stringency index, number of tests, and active cases were analyzed. Using a linear regression model, an independent variable was utilized for a given date to predict the future number of community cases. Results: Research results show that outpatient cases, the stringency, and Google Mobility Trend were all significantly associated with the number of COVID-19 community cases from the sixth day to the ninth day. The model predicting community cases on the eighth day (R2=0.8906) was the most appropriate showing outpatients, residential index, grocery and pharmacy index, retail and recreation index, and workplaces index were positively related (ß1=24.2, 95% CI: 20.3- 26.3, P<0.0001; ß2=277.7, 95% CI: 171.8-408.2, P<0.0001; ß3=112.4, 95% CI: 79.8-158.3, P<0.0001; ß4=73.1, 95% CI: 53- 04.4, P<0.0001; ß5=57.2, 95% CI: 25.2-96.8, P=0.001, respectively). In contrast, inpatients, park index, and adjusted stringency index were negatively related to the number of community cases (ß6=-2.8, 95% CI: -3.9 - -1.6, P<0.0001; ß7=-33, 95% CI: -43.6 - -27, P<0.0001; ß8=-14.4, 95% CI: -20.1- -12, P<0.0001, respectively). Conclusion: Outpatient cases and indexes of Community Mobility Reports were associated with COVID-19 community cases.

Identifying SARS-CoV2 transmission cluster category: An analysis of country government database.

BACKGROUND: As a result of the high contagiousness and transmissibility of SARS-CoV-2, studying the location of the case clusters that will follow, will help understand the risk factors related to the disease transmission. In this study, we aim to identify the transmission cluster category and settings that can guide decision-makers which areas to be opened again. METHODS: A thorough review of the literature and the media articles were performed. After data verification, we included cluster data from eight countries as of 16th May 2020. Clusters were further categorized into 10 categories and analysis was performed. The data was organized and presented in an easily accessible online sheet. RESULTS: Among the eight included countries, we have found 3905 clusters and a total number of 1,907,944 patients. Indoor settings (mass accommodation and residential facilities) comprised the highest number of both number of clusters (3315/3905) and infected patients (1,837,019/1,907,944), while the outdoor ones comprised 590 clusters and 70,925 patients. Mass accommodation was associated with the highest number of cases in 5 of the 7 countries with data available. Social events and residential settings were responsible for the highest number of cases in the two remaining countries. In the USA, workplace facilities have reported 165 clusters of infection including 122 food production facilities. CONCLUSIONS: Lockdown could truly be a huge burden on a country's economy. However, with the proper knowledge concerning the transmissibility and the behaviour of the disease, better decisions could be made to guide the appropriate removal of lockdown across the different fields and regions.

Coronavirus Disease (COVID-19): Comprehensive Review of Clinical Presentation.

COVID-19 is a rapidly growing pandemic with its first case identified during December 2019 in Wuhan, Hubei Province, China. Due to the rampant rise in the number of cases in China and globally, WHO declared COVID-19 as a pandemic on 11th March 2020. The disease is transmitted via respiratory droplets of infected patients during coughing or sneezing and affects primarily the lung parenchyma. The spectrum of clinical manifestations can be seen in COVID-19 patients ranging from asymptomatic infections to severe disease resulting in mortality. Although respiratory involvement is most common in COVID-19 patients, the virus can affect other organ systems as well. The systemic inflammation induced by the disease along with multisystem expression of Angiotensin Converting Enzyme 2 (ACE2), a receptor which allows viral entry into cells, explains the manifestation of extra-pulmonary symptoms affecting the gastrointestinal, cardiovascular, hematological, renal, musculoskeletal, and endocrine system. Here, we have reviewed the extensive literature available on COVID-19 about various clinical presentations based on the organ system involved as well as clinical presentation in specific population including children, pregnant women, and immunocompromised patients. We have also briefly discussed about the Multisystemic Inflammatory Syndrome occurring in children and adults with COVID-19. Understanding the various clinical presentations can help clinicians diagnose COVID-19 in an early stage and ensure appropriate measures to be undertaken in order to prevent further spread of the disease.

Reduction in energy for electrochemical disinfection of E. coli in urine simulant.

ABSTRACT: We report the development of novel modes of operation for electrochemical disinfection of E. coli in human urine simulant with an aim to minimize the energy required for disinfection. The system employs boron-doped diamond electrodes and will be part of an energy neutral, water and additive free outdoor toilet being developed for use in developing countries. Disinfection had been previously demonstrated with voltage being continuously applied to the electrode until disinfection was achieved. In the present study, a new pulsed mode of operation is investigated. This includes a continuous on mode, where oxidants are generated until disinfection is achieved, a single cycle mode, where oxidants are generated for a fixed time and the water is circulated so allow already generated oxidants to disinfect, and a pulsed mode with different duty cycles, which is like the single cycle mode but with multiple cycles. Disinfection was achieved with pulsed mode operation with a 68% energy reduction compared to the continuous on mode. Energy saving was most likely achieved by lengthening the contact time of the disinfectant with the bacteria and increased generation of non-chlorine disinfecting oxidants.