scholarly journals Rhino-orbito-Cerebral mucormycosis during COVID 19 pandemic in western Uttar Pradesh India

2021 ◽  
Vol 4 (3) ◽  
pp. 94-97
Author(s):  
Mohit Srivastava ◽  
Keshav Gupta ◽  
Veenita Singh
Keyword(s):  
Early Diagnosis ◽  
Uttar Pradesh ◽  
High Dose ◽  
Mortality And Morbidity ◽  
Sudden Rise ◽  
Type2 Diabetes ◽  
Total Treatment ◽  
History Of ◽  
High Doses ◽  
Type2 Diabetes Mellitus

Mucormycosis (Black fungus) is a designated as a rare, rapidly progressive fatal disease of immunocompromised caused by saprophytic fungus of family mucorales. Early diagnosis with prompt medical and surgical treatment is the only tool available. Rhino-orbito-cerebral is the most common subtype. In India we saw a sudden rise in mucormycosis cases during second wave of COVID 19. This necessitated a systematic review of epidemic of mucormycosis in COVID 19.A Retrospective multi-centric study was conducted comprising of 51 cases of Rhino-orbito-cerebral mucormycosis with present or recent COVID19 in Western Uttar Pradesh positive status presenting to us during 14 April 2021- 31 May 2021.Either Type2 Diabetes Mellitus or history of recent use of steroids in high doses was present in all the patients. Contribution of virulence of the Delta strain B1.617.2 is significant. FESS with sino-nasal debridement contributes significantly towards mortality reduction and cost of total treatment by significantly reducing days of Liposomal Amphotericin B therapy.Early diagnosis with prompt medical and surgical management along with blood sugar control and avoiding use of high dose of steroids remain to key to mortality and morbidity reduction.

scholarly journals RHINO-ORBITO-CEREBRAL MUCORMYCOSIS (BLACK FUNGUS) IN COVID 19 PATIENTS

2021 ◽  
Vol Volume 9 (upjohns/volume9/Issue2) ◽  
pp. 27-31
Author(s):  
Keshav Gupta
Keyword(s):  
Early Diagnosis ◽  
High Dose ◽  
Mortality And Morbidity ◽  
Sudden Rise ◽  
Type2 Diabetes ◽  
Total Treatment ◽  
History Of ◽  
High Doses ◽  
Type2 Diabetes Mellitus ◽  
Second Wave

ABSTRACT BACKGROUND Mucormycosis (Black fungus) is a designated as a rare, rapidly progressive fatal disease of immunocompromised caused by saprophytic fungus of family mucorales. Early diagnosis with prompt medical and surgical treatment is the only tool available. Rhino-orbito-cerebral is the most common subtype. In India we saw a sudden rise in mucormycosis cases during second wave of COVID 19. This necessitated a systematic review of epidemic of mucormycosis in COVID 19. METHODS A Retrospective multi-centric study was conducted at various Government and Private Hospitals of Western UP comprising of 51 cases of Rhino-orbitocerebral mucormycosis with present or recent COVID19 positive status presenting to us during 14th April 2021- 31st May 2021. RESULT Either Type2 Diabetes Mellitus or history of recent use of steroids in high doses was present in all the patients. Contribution of virulence of the Delta strain B1.617.2 is significant. FESS with sino-nasal debridement contributes significantly towards mortality reduction and cost of total treatment by significantly reducing days of Liposomal Amphotericin B therapy. CONCLUSION Early diagnosis with prompt medical and surgical management along with blood sugar control and avoiding use of high dose of steroids remain to key to mortality and morbidity reduction. Keywords: Black fungus, mucor, mucormycosis, rhino-orbito-cerebral, causes, treatment, covid 19, India, sugar, steroids, steam, oxygen, surgery

Perioperative dilemma: Challenges of the management of a patient on mega doses of morphine and methadone

2014 ◽  
Vol 10 (1) ◽  
pp. 69 ◽  
Author(s):  
Alan David Kaye, MD, PhD, DABA, DABPM, DABIPP ◽  
Aymen A. Alian, MD ◽  
Nalini Vadivelu, MD ◽  
Keun Sam Chung, MD
Keyword(s):  
Back Pain ◽  
Case Report ◽  
High Dose ◽  
Successful Management ◽  
Present Case Report ◽  
Opioid Induced Hyperalgesia ◽  
History Of ◽  
High Doses

High doses of opioids are often needed in the management of cancer-related pain. A discussion of a patient’s perioperative opioid management and mechanisms contributing to opioid-induced hyperalgesia (OIH) are presented. In the present case report, a patient on high doses of opioids, including morphine and methadone, with severe worsening back pain and a history of increasing opioid requirements for the last 2 months due to metastatic leiomyosarcoma to the femur, spine, and neck is described. Use of high dose opioids is associated with numerous challenges, including tolerance. The successful management of this patient was multimodal and included the use of potent analgesics, N-methyl-D-aspartatereceptor antagonists, and the α-2 agonist clonidine.

scholarly journals Additive effect of dabigatran and high-dose aspirin in the development of haemorrhagic pleural effusion in a patient with tuberculous pleuritis

2020 ◽  
Vol 32 (3) ◽  
pp. 176-179
Author(s):  
Duygu Karagül
Keyword(s):  
Pleural Effusion ◽  
Dabigatran Etexilate ◽  
Chronic Atrial Fibrillation ◽  
The Elderly ◽  
Additive Effect ◽  
High Dose ◽  
History Of ◽  
Chest X Ray ◽  
Polymerase Chain ◽  
High Doses

Tuberculous pleuritis can rarely cause haemorrhagic pleural effusion. Dabigatran etexilate can have an additive effect on increasing the risk of haemorrhage. Aspirin cannot cause major haemorrhage, but in the elderly it can cause gastrointestinal bleeding via ulceration of the gastrointestinal mucosa. We report here the case of a 77-year-old male who presented to the hospital with a 2-month history of progressive dyspnoea. He had been taking dabigatran etexilate (220 mg) and high-dose acetylsalicylic acid (aspirin; 300 mg) daily for chronic atrial fibrillation. A chest X-ray revealed a moderately sized right pleural effusion confirmed by a computed tomography scan, which also showed bronchiectasis of both lungs. Dabigatran was discontinued and aspirin was decreased to the minimal therapeutic dose of 100 mg before thoracentesis was performed. Lymphocyte-predominant (50%) haemorrhagic fluid of 500 ml was drained, positive for acid-fast bacilli smear and polymerase chain reaction of Mycobacterium tuberculosis. A chest tube was placed and an additional 1250 ml of haemorrhagic exudate drained out. We treated the patient with a routine regimen of antituberculous medication and the infection resolved without complications other than the bronchiectasis present before treatment. We think that the combination of dabigatran etexilate and high doses of aspirin increased the risk of pleural haemorrhage in this patient with tuberculous pleuritis

Neurotoxicity associated with systemic high-dose cytosine arabinoside.

1986 ◽  
Vol 4 (4) ◽  
pp. 571-575 ◽  
Author(s):  
S Nand ◽  
H L Messmore ◽  
R Patel ◽  
S G Fisher ◽  
R I Fisher
Keyword(s):  
Cytosine Arabinoside ◽  
Past History ◽  
Significant Proportion ◽  
Signs And Symptoms ◽  
High Dose ◽  
Cerebellar Dysfunction ◽  
History Of ◽  
Prophylactic Use ◽  
High Doses ◽  
Acute Nonlymphoblastic Leukemia

High doses of cytosine arabinoside (ara-C) have been used in the treatment of refractory forms of acute nonlymphoblastic leukemia (ANLL) and ANLL occurring after previous antineoplastic therapy. In addition to the usual toxicities associated with antimetabolites, neurotoxicity, mainly in the form of cerebellar dysfunction, develops in a significant proportion of patients receiving high-dose cytosine arabinoside HDara-C. This study was performed to determine the incidence of cerebellar dysfunction in our patients and to determine any factors that predict its development. In this series of 30 consecutive patients receiving HDara-C, confusion with cerebellar signs and symptoms developed in seven (23%). Factors that appear to predispose patients to the development of neurotoxicity are (1) past history of neurologic dysfunction and (2) preexisting and progressive hepatic dysfunction. No peripheral neuropathy was seen. In contrast to previous reports, we did not find neurotoxicity to be dose related. Prophylactic use of pyridoxine does not prevent neurotoxicity.

scholarly journals First Degree Relatives of Bangladeshi Prediabetic Subjects are at Increased Risk for Developing Glucose Intolerance

1970 ◽  
Vol 29 (1) ◽  
pp. 21-26
Author(s):  
SM Shefin ◽  
MO Faruque ◽  
SH Khandker ◽  
ZA Latif ◽  
L Ali
Keyword(s):  
Genetic Susceptibility ◽  
Glucose Intolerance ◽  
First Generation ◽  
First Degree Relatives ◽  
Type2 Diabetes ◽  
Increased Risk ◽  
History Of ◽  
Bangladeshi Population ◽  
Type2 Diabetes Mellitus ◽  
Major Target

Background: The racial variation in genetic susceptibility of Type2 diabetes mellitus is well established. The stages of impaired fasting glucose (IFG) and/or Impaired glucose tolerance (IGT) (collectively known as ‘prediabetic stages) are combined to be intermediate in the natural history of diabetes, but their genetic susceptibility are still a matter of investigation. Family study is the primary step to explore genetic susceptibility. In particular, there has been no study in Bangladesh related to genetics of prediabetes. Objectives: The present study aimed to explore the genetic susceptibility of prediabetes in Bangladeshi population by observing the clustering of dysglycemia in first degree relatives of prediabetes. Methodology: The study was designed as an experimental group comparison study. Newly detected prediabetic subjects (isolated IFG, IGT, IFG+IGT) were collected from BIRDEM OPD and reconfirmed by OGTT following WHO guidelines and sub grouped. Relatives of the prediabetes, up to first generation, were included as cases and termed as R-IFG (first degree relatives of IFG), R-IGT (first degree relatives of IGT), R-IFG-IGT (first degree relatives of IFG-IGT) corresponding to the subgroups of prediabetes. Each relative underwent an OGTT following the same guideline. Blood glucose was measured by glucose oxidase method. Results: Different types of prediabetic subjects (IFG, IGT, IFG+IGT) and their first degree relatives (R_IFG, R_IGT, R_IFG+IGT) were studied. Among 41 first degree relatives of IFG (R_IFG), 2 (4.9%) had IFG, 4 (9.8%) had IGT, 1 (2.4%) had combined IFG+IGT, 5 (12.5%) had T2 DM and 29 (70.7%) had normoglycemia. Among 116 first degree relatives of IGT (R_IGT) none (0.00%) had IFG, 15 (12.9%) had IGT, 2 (1.7%) had combined IFG+IGT, 22 (19%) had diabetes and 77 (66.4%) having absolutely normal OGTT reports. Among 76 first degree relatives of IFG+IGT (R_IFG+IGT), 2 (2.6%) had IFG, 4 (5.3%) had IGT, 1 (1.3%) had combined IFG+IGT, 19 (25%) had diabetes and 50 (65.8%) were normoglycemic. Conclusion: Clustering of pre-diabetes and diabetes is present in families of prediabetic subjects and they should be taken as a major target for primary prevention of these disorders. Key words: Prediabetes; IFG; IGT; IFG+IGT; First degree relatives; Glucose intolerance. DOI: 10.3329/jbsp.v29i1.7167J Bangladesh Coll Phys Surg 2011; 29:21-26

ITI with high-dose FIX and combined immunosuppressive therapy in a patient with severe haemophilia B and inhibitor

2009 ◽  
Vol 29 (02) ◽  
pp. 155-157 ◽  
Author(s):  
H. Hauch ◽  
J. Rischewski ◽  
U. Kordes ◽  
J. Schneppenheim ◽  
R. Schneppenheim ◽  
...  
Keyword(s):  
Nephrotic Syndrome ◽  
Immunosuppressive Agents ◽  
Tolerance Induction ◽  
Intravenous Immunoglobulins ◽  
Factor Ix ◽  
High Dose ◽  
Allergic Reactions ◽  
Success Rates ◽  
Serious Infections ◽  
History Of

SummaryInhibitor development is a rare but serious event in hemophilia B patients. Management is hampered by the frequent occurrence of allergic reactions to factor IX, low success rates of current inhibitor elimination protocols and the risk of development of nephrotic syndrome. Single cases of immune tolerance induction (ITI) including immunosuppressive agents like mycophenolat mofetil (MMF) or rituximab have been reported. We present a case of successful inhibitor elimination with a combined immune-modulating therapy and high-dose factor IX (FIX). This boy had developed a FIX inhibitor at the age of 5 years and had a history of allergic reactions to FIX and to FEIBA→. Under on-demand treatment with recombinant activated FVII the inhibitor became undetectable but the boy suffered from multiple joint and muscle bleeds. At the age of 11.5 years ITI was attempted with a combination of rituximab, MMF, dexamethasone, intravenous immunoglobulins and high-dose FIX. The inhibitor did not reappear and FIX half-life normalized. No allergic reaction, no signs of nephrotic syndrome and no serious infections were observed.

The Influence of Serotonin on Clot Retraction and the Thrombelastogram

1958 ◽  
Vol 02 (01/02) ◽  
pp. 111-124 ◽  
Author(s):  
E Deutsch ◽  
K Martiny
Keyword(s):  
Human Plasma ◽  
Human Platelet ◽  
Platelet Rich Plasma ◽  
Specific Effect ◽  
High Dose ◽  
Clot Retraction ◽  
Platelet Counts ◽  
Essential Value ◽  
High Doses ◽  
Free Plasma

Summary1. Normal platelets are necessary for induction of normal clot retraction.2. Serotonin does not induce retraction in human platelet-free plasma-clots or enhance clot firmness as measured in the coagulogram.3. Serotonin does not improve clot retraction or firmness in plasma clots with sub-optimal platelet counts.4. Methylserotonin inhibits clot retraction of platelet-rich plasma to a certain extent in moderate doses, whereas, high doses are ineffective. BOL 148 has a similar, but less significant action. There is a possibility that these effects are specific antiserotonin-effects.5. LSD 25 was ineffective in all concentrations used.6. Largactil and reserpin inhibit retraction in high doses. There seems to be a non specific effect caused by the high dose.7. Reserpine does not release a retraction-inducing agent from the platelets, which could be detected in the centrifuged platelet-free plasma used for the incubation.8. Serotonin does not replace the retraction-cofactor of Hartert, or the dialyzable factor of Lüscher in synthetic clotting substrates.9. Serotonin is of no essential value in inducing normal retraction of human plasma clots.

Ghrelin and Obesity-An Update

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Gandhi M. ◽  
Swaminathan S.
Keyword(s):  
Diabetes Mellitus ◽  
Cardiac Output ◽  
Energy Balance ◽  
Vascular Resistance ◽  
The Body ◽  
Ghrelin Receptor ◽  
Type2 Diabetes ◽  
Type2 Diabetes Mellitus ◽  
Natural Hormones

Ghrelin as human natural hormones is involved in fundamental regulatory process of eating and energy balance. It is a stomach derived hormone that acts as at the ghrelin receptor in multiple tissues throughout to the body. Its properties includes increasing appetite, decreasing systemic inflammation, decreasing vascular resistance ,increasing cardiac output, increasing glucose and IGF-1 levels, Hence it may play a significant role in Diabetes mellitus. Many studies have linked ghrelin to obesity and this paper is an attempt to bring out recent findings on the role of ghrelin in Diabetes Mellitus, particularly type2 Diabetes mellitus.

Serum level of Arginine and Symmetric dimethyl arginine in patients with prediabetes and type2 diabetes mellitus

2019 ◽  
Vol 22 (12) ◽  
pp. 218-226
Author(s):  
Basheer Sultan Dayir ◽  
Mohammed I. Hamzah ◽  
Mahmood S.H. Khudair
Keyword(s):  
Diabetes Mellitus ◽  
Serum Level ◽  
Type2 Diabetes ◽  
Type2 Diabetes Mellitus ◽  
Dimethyl Arginine
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