Mucormycosis an avoidable complication of COVID-19: a case report

Mucormycosis is caused by the fungi belonging to the order Mucorales. There has been an increasing trend of rising fungal infection during the second wave of COVID in India, seen among patients recovering from COVID-19. A 37-years-old middle-aged adult, with the diagnosis of left paranasal sinus mucormycosis, left side pneumothorax (intercostal drainage tube in-situ) with COVID pneumonia reported to the emergency department (ED) during the COVID-19 pandemic in our hospital in India. The patient presented in the ED on oxygen support via a non-rebreathing mask at rate of 10 l/min with a history of progressive left eye redness, pain, and tenderness, periorbital swelling, sudden onset, and mild shortness of breath from 8 days. The patient had a history of taking steroids during the management of COVID-19, also had left intercostal drainage tube (ICD) in-situ, and underwent post endoscopic sinus surgery in the private hospital. The patient was clinically examined by multispeciality experts and subjected to laboratory investigations. The patient was diagnosed with left PNS mucormycosis and planned for debridement. The patient developed renal failure secondary to antifungal therapy had sudden deterioration and could not be saved. The mortality rate of mucormycosis is very high due to delayed presentation, toxicity associated with the antifungal therapy, etc. There is a need to identify risk factors, perform specific laboratory tests, and initiation of prompt treatment. Monitoring and competent nursing care are required during antifungal therapy and prolonged hospital stay.

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Covid-19 Associated Hepatitis in children (CACH) during the second wave of SARS-CoV-2 infections in Central India: Is it a complication or transient phenomenon.

10.1101/2021.07.23.21260716 ◽

2021 ◽

Author(s):

Sumit K Rawat ◽

Ajit anand Asati ◽

Ashish Jain ◽

Radha Kant Ratho

Keyword(s):

Acute Hepatitis ◽

Inflammatory Markers ◽

Pediatric Patients ◽

High Titer ◽

Central India ◽

Clinical Work ◽

Sudden Onset ◽

Temporal Association ◽

History Of ◽

Second Wave

Background: Besides Covid-19, SARS-CoV-2 infection has been associated with Multiple Inflammatory Syndrome in children (MIS-C). However, a unique presentation of a transient form of hepatitis in pediatric age group occurring subsequent to the asymptomatic SARS-CoV-2 infection is yet to be reported in children. Presently the clinical work, temporal association and characteristics different than MIS-C of the cases of CAHC is being dealt with. Methods: As a retrospective and follow up observational study we reviewed all pediatric patients presenting with acute hepatitis during the study period from April 2021 to mid- June 2021. We observed a sudden rise of features of hepatitis in a group of pediatric patients during the second wave of SARS CoV-2 infections, where children or adolescents developing sudden onset acute hepatitis with no history of pre-existing liver disease in the absence of familiar etiology of acute hepatitis and with a recent 3-6 week history of RT-PCR positivity or a retrospectively proven Covid-19 infection with high titer SARS CoV-2 antibodies. Such patients had asymptomatic Covid-19 infection, while another very small group (n=8) patients having findings similar to MIS-C was identified with protracted and grave presentation, having multiple organ involvement along with Covid-19 diagnosis. Routine lab workup along with viral serology of acute hepatitis was performed in all such patients. These patients were negative for Hepatitis A, B, C and E but had high titer of SARS CoV-2 antibodies. Results: Among 33 patients who presented with hepatitis, 25 patients showed unique features of CAHC, they had hepatitis only. These patients did not have any typical Covid-19 symptoms, had normal to borderline inflammatory markers, with admission to general care wards, all recovered on supportive treatment without any complications or mortality. Whereas patients with MIS-C (n=8) required admission to critical care, they had high level of inflammatory markers and 3 (37.5%) had an adverse outcome. Conclusion: With emergence of newer variants of concern such as the Delta variant which caused the massive wave of Covid-19 in India, with varied presentations, CAHC is one of them. Such new entities need to be timely identified and differentiated from other types of emerging syndromes in children for appropriate management.

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Profile of Mucormycosis Cases from a Network of Hospitals in North India Amidst COVID-19 Pandemic

10.1101/2021.08.25.21262404 ◽

2021 ◽

Author(s):

Sandeep Budhiraja ◽

Mona Aggarwal ◽

Monica Mahajan ◽

Abhaya Indrayan ◽

Vinitaa Jha ◽

...

Keyword(s):

Antifungal Drugs ◽

North India ◽

Sinus Surgery ◽

Primary Surgery ◽

Eortc Criteria ◽

History Of ◽

Eye Involvement ◽

History Of Use ◽

Multiple Symptoms ◽

Second Wave

Incidence of mucormycosis suddenly surged in India after the second wave of COVID-19. This is a crippling disease and needs to be studied in detail to understand the disease, its course, and the outcomes. Between 1st March and 15th July 2021, our network of hospitals in North India received a total of 155 cases of COVID-associated mucormycosis cases as all of them reported affliction by COVID-19 earlier or concurrent. Their records were retrieved from the Electronic Health Records system of the hospitals and their demographics, clinical features, treatments, and outcomes were studied. More than 80% (125 cases) had proven disease and the remaining 30 were categorized as possible mucormycosis as per the EORTC criteria. More than two-thirds (69.0%) of the cases were males and the mean age was 53 years for either sex. Nearly two-thirds (64.5%) had symptoms of nose and jaws and 42.6% had eye involvement. Some had multiple symptoms. As many as 78.7% had diabetes and 91.6% gave history of use of steroids during COVID-19 treatment. The primary surgery was functional endoscopic sinus surgery (FESS) (83.9%). Overall mortality was 16.8%, which is one-and-a-half times the mortality in hospitalized COVID-19 patients in the corresponding population. Occurrence of mucormycosis was associated with diabetes and use of steroids, but mortality was not associated with either of them. Cases undergoing surgery and on antifungal had steeply lower mortality (11.9% vs. 50.0%, P < 0.001) than those who were exclusively on antifungal drugs. Treatment by different drugs did not make much of a difference in mortality.

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Rapid evolution and host immunity drive the rise and fall of carbapenem resistance during an acute Pseudomonas aeruginosa infection

Nature Communications ◽

10.1038/s41467-021-22814-9 ◽

2021 ◽

Vol 12 (1) ◽

Author(s):

Rachel Wheatley ◽

Julio Diaz Caballero ◽

Natalia Kapel ◽

Fien H. R. de Winter ◽

Pramod Jangir ◽

...

Keyword(s):

Pseudomonas Aeruginosa ◽

Efflux Pump ◽

Rapid Evolution ◽

Carbapenem Resistance ◽

Host Immunity ◽

High Definition ◽

Loss Of Resistance ◽

Pseudomonas Aeruginosa Infection ◽

Second Wave

AbstractIt is well established that antibiotic treatment selects for resistance, but the dynamics of this process during infections are poorly understood. Here we map the responses of Pseudomonas aeruginosa to treatment in high definition during a lung infection of a single ICU patient. Host immunity and antibiotic therapy with meropenem suppressed P. aeruginosa, but a second wave of infection emerged due to the growth of oprD and wbpM meropenem resistant mutants that evolved in situ. Selection then led to a loss of resistance by decreasing the prevalence of low fitness oprD mutants, increasing the frequency of high fitness mutants lacking the MexAB-OprM efflux pump, and decreasing the copy number of a multidrug resistance plasmid. Ultimately, host immunity suppressed wbpM mutants with high meropenem resistance and fitness. Our study highlights how natural selection and host immunity interact to drive both the rapid rise, and fall, of resistance during infection.

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North polar trough formation due to in-situ erosion as a source of young ice in mid-latitudinal mantles on Mars

Scientific Reports ◽

10.1038/s41598-021-83329-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

J. Alexis P. Rodriguez ◽

Kenneth L. Tanaka ◽

Ali M. Bramson ◽

Gregory J. Leonard ◽

Victor R. Baker ◽

...

Keyword(s):

Katabatic Wind ◽

Spiral Pattern ◽

Near Surface ◽

Valuable Source ◽

History Of ◽

North Polar ◽

Human Exploration ◽

Erosional Event

AbstractThe clockwise spiral of troughs marking the Martian north polar plateau forms one of the planet’s youngest megastructures. One popular hypothesis posits that the spiral pattern resulted as troughs underwent poleward migration. Here, we show that the troughs are extensively segmented into enclosed depressions (or cells). Many cell interiors display concentric layers that connect pole- and equator-facing slopes, demonstrating in-situ trough erosion. The segmentation patterns indicate a history of gradual trough growth transversely to katabatic wind directions, whereby increases in trough intersections generated their spiral arrangement. The erosional event recorded in the truncated strata and trough segmentation may have supplied up to ~25% of the volume of the mid-latitude icy mantles. Topographically subtle undulations transition into troughs and have distributions that mimic and extend the troughs’ spiraling pattern, indicating that they probably represent buried trough sections. The retention of the spiral pattern in surface and subsurface troughs is consistent with the megastructure’s stabilization before its partial burial. A previously suggested warm paleoclimatic spike indicates that the erosion could have occurred as recently as ~50 Ka. Hence, if the removed ice was redeposited to form the mid-latitude mantles, they could provide a valuable source of near-surface, clean ice for future human exploration.

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Development of a Field Deployable Firebrand Flux and Condition Measurement System

Fire Technology ◽

10.1007/s10694-020-01074-x ◽

2020 ◽

Author(s):

Simone Zen ◽

Jan C. Thomas ◽

Eric V. Mueller ◽

Bhisham Dhurandher ◽

Michael Gallagher ◽

...

Keyword(s):

Imaging Techniques ◽

Time History ◽

Infrared Camera ◽

Thermal Conditions ◽

Particle Characterization ◽

Fire Dynamics ◽

Rate Of Spread ◽

New Instrument ◽

History Of

AbstractA new instrument to quantify firebrand dynamics during fires with particular focus on those associated with the Wildland-Urban Interface (WUI) has been developed. During WUI fires, firebrands can ignite spot fires, which can rapidly increase the rate of spread (ROS) of the fire, provide a mechanism by which the fire can pass over firebreaks and are the leading cause of structure ignitions. Despite this key role in driving wildfire dynamics and hazards, difficulties in collecting firebrands in the field and preserving their physical condition (e.g. dimensions and temperature) have limited the development of knowledge of firebrand dynamics. In this work we present a new, field-deployable diagnostic tool, an emberometer, designed to provide measurement of firebrand fluxes and information on both the geometry and the thermal conditions of firebrands immediately before deposition by combining a visual and infrared camera. A series of laboratory experiments were conducted to calibrate and validate the developed imaging techniques. The emberometer was then deployed in the field to explore firebrand fluxes and particle conditions for a range of fire intensities in natural pine forest environments. In addition to firebrand particle characterization, field observations with the emberometer enabled detailed time history of deposition (i.e. firebrand flux) relative to concurrent in situ fire behaviour observations. We highlight that deposition was characterised by intense, short duration “showers” that can be reasonably associated to spikes in the average fire line intensity. The results presented illustrate the potential use of an emberometer in studying firebrand and spot fire dynamics.

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In Situ exploration of the giant planets

Experimental Astronomy ◽

10.1007/s10686-021-09775-z ◽

2021 ◽

Author(s):

O. Mousis ◽

D. H. Atkinson ◽

R. Ambrosi ◽

S. Atreya ◽

D. Banfield ◽

...

Keyword(s):

Solar System ◽

Giant Planets ◽

Atmospheric Composition ◽

Formation History ◽

History Of ◽

Composition Structure ◽

Galileo Probe ◽

Probe Measurements

AbstractRemote sensing observations suffer significant limitations when used to study the bulk atmospheric composition of the giant planets of our Solar System. This impacts our knowledge of the formation of these planets and the physics of their atmospheres. A remarkable example of the superiority of in situ probe measurements was illustrated by the exploration of Jupiter, where key measurements such as the determination of the noble gases’ abundances and the precise measurement of the helium mixing ratio were only made available through in situ measurements by the Galileo probe. Here we describe the main scientific goals to be addressed by the future in situ exploration of Saturn, Uranus, and Neptune, placing the Galileo probe exploration of Jupiter in a broader context. An atmospheric entry probe targeting the 10-bar level would yield insight into two broad themes: i) the formation history of the giant planets and that of the Solar System, and ii) the processes at play in planetary atmospheres. The probe would descend under parachute to measure composition, structure, and dynamics, with data returned to Earth using a Carrier Relay Spacecraft as a relay station. An atmospheric probe could represent a significant ESA contribution to a future NASA New Frontiers or flagship mission to be launched toward Saturn, Uranus, and/or Neptune.

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Gaia DR1 completeness within 250 pc & star formation history of the Solar neighbourhood

Proceedings of the International Astronomical Union ◽

10.1017/s1743921317006159 ◽

2017 ◽

Vol 12 (S330) ◽

pp. 148-151 ◽

Cited By ~ 1

Author(s):

Edouard J. Bernard

Keyword(s):

Star Formation ◽

Star Formation History ◽

Solar Neighbourhood ◽

The Sun ◽

Thick Disc ◽

Formation History ◽

Magnitude Diagram ◽

History Of

AbstractWe took advantage of the Gaia DR1 to combine TGAS parallaxes with Tycho-2 and APASS photometry to calculate the star formation history (SFH) of the solar neighbourhood within 250 pc using the colour-magnitude diagram fitting technique. We present the determination of the completeness within this volume, and compare the resulting SFH with that calculated from the Hipparcos catalogue within 80 pc of the Sun. We also show how this technique will be applied out to ~5 kpc thanks to the next Gaia data releases, which will allow us to quantify the SFH of the thin disc, thick disc and halo in situ, rather than extrapolating based on the stars from these components that are today in the solar neighbourhood.

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The merger-driven evolution of massive early-type galaxies

Proceedings of the International Astronomical Union ◽

10.1017/s1743921320002434 ◽

2020 ◽

Vol 15 (S359) ◽

pp. 62-66

Author(s):

Carlo Cannarozzo ◽

Carlo Nipoti ◽

Alessandro Sonnenfeld ◽

Alexie Leauthaud ◽

Song Huang ◽

...

Keyword(s):

Mass Velocity ◽

Selection Criteria ◽

Velocity Dispersion ◽

Ex Situ ◽

Scaling Relations ◽

Early Type ◽

History Of ◽

Kinematic Properties ◽

Shed Light

AbstractThe evolution of the structural and kinematic properties of early-type galaxies (ETGs), their scaling relations, as well as their stellar metallicity and age contain precious information on the assembly history of these systems. We present results on the evolution of the stellar mass-velocity dispersion relation of ETGs, focusing in particular on the effects of some selection criteria used to define ETGs. We also try to shed light on the role that in-situ and ex-situ stellar populations have in massive ETGs, providing a possible explanation of the observed metallicity distributions.

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Uretero-Iliac artery fistula: a rare cause of haematuria

BMJ Case Reports ◽

10.1136/bcr-2019-232189 ◽

2020 ◽

Vol 13 (9) ◽

pp. e232189

Author(s):

Natalia Hernandez ◽

Bethany Desroches ◽

Eric Peden ◽

Raj Satkunasivam

Keyword(s):

Iliac Artery ◽

Percutaneous Nephrostomy ◽

Arterial System ◽

Endoscopic Evaluation ◽

Stent Removal ◽

Retrograde Pyelogram ◽

History Of ◽

Gross Haematuria ◽

Multiple Episodes

A woman in her mid-forties with a history of cervical cancer requiring chemoradiation presented with bilateral ureteral strictures secondary to radiation therapy. The ureteral obstruction was initially relieved with bilateral percutaneous nephrostomy tubes, and subsequently, bilateral ureteral stents. Over the course of 8 months, she presented with multiple episodes of severe gross haematuria. This persisted even after stent removal and conversion back to percutaneous nephrostomy tubes. The initial evaluation, done with concern for an uretero-iliac artery fistula, which included bilateral retrograde pyelograms and CT angiography was non-diagnostic. Given continued haematuria, repeat endoscopic evaluation was undertaken; on retrograde pyelogram, brisk contrast was seen to pass into the arterial system, consistent with a left ureteroarterial fistula. The patient underwent endovascular iliac artery stent placement. Subsequently, the patient underwent resection of the iliac artery with endovascular graft in situ, left distal ureterectomy with proximal ureteral ligation following femoral-to-femoral bypass. This allowed for complete resolution of the patient’s gross haematuria episodes.

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Sigmoid Volvulus in 16-year-old Boy with an Associated Anomalous Congenital Band

The American Surgeon ◽

10.1177/000313481307901114 ◽

2013 ◽

Vol 79 (11) ◽

pp. 1140-1141 ◽

Cited By ~ 4

Author(s):

Ann A. Albert ◽

Tracy L. Nolan ◽

Bryan C. Weidner

Keyword(s):

Abdominal Pain ◽

African American Male ◽

Pediatric Patients ◽

Primary Anastomosis ◽

Exploratory Laparotomy ◽

Sigmoid Volvulus ◽

Sudden Onset ◽

Contrast Enema ◽

Pediatric Age Group ◽

History Of

Sigmoid volvulus, a condition generally seen in debilitated elderly patients, is extremely rare in the pediatric age group. Frequent predisposing conditions that accompany pediatric sigmoid volvulus include intestinal malrotation, omphalomesenteric abnormalities, Hirschsprung's disease, imperforate anus and chronic constipation. A 16-year-old previously healthy African American male presented with a 12 hour history of sudden onset abdominal pain and intractable vomiting. CTwas consistent with sigmoid volvulus. A contrast enema did not reduce the volvulus, but it was colonoscopically reduced. Patient condition initially improved after colonoscopy, but he again became distended with abdominal pain, so he was taken to the operating room. On exploratory laparotomy, a band was discovered where the mesenteries of the sigmoid and small bowel adhered and created a narrow fixation point around which the sigmoid twisted. A sigmoidectomy with primary anastomosis was performed. The diagnosis of sigmoid volvulus may be more difficult in children, with barium enema being the most consistently helpful. Seventy percent of cases do not involve an associated congenital problem, suggesting that some pediatric patients may have congenital redundancy of the sigmoid colon and elongation of its mesentery. The congenital band found in our patient was another potential anatomic factor that led to sigmoid volvulus. Pediatric surgeons, accustomed to unusual problems in children, may thus encounter a condition generally found in the debilitated elderly patient.

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