Rhinoorbital mucormycosis in COVID-19 pandemic: presentation and course of disease: An observational study

During the second wave of covid 19[SARS- Co V-] pandemic, there is a sudden increase in number of mucormycosis infection cases in India. The present study is an attempt to understand the presentation, course and outcome of rhinoorbital mucormycosis in a group of patients who reported to Ophtalmology and Otorhinolaryngology department of our Govt. District Hospital (secondary referral centre) for enhancing measures for prevention and management. Patients who reported to our Government district hospital with signs or symptoms suggestive of rhino orbital mucormycosis during May-June 2021 were included in the study with consent of ethical committee, patients and patient’s relatives. Total 17 cases were reported and followed. Clinical examination was done for all the patients. History of the presenting complaints and underlying illness with COVID -19 was elicited. Underlying comorbid status was recorded. Patients were followed as all of them were referred to higher centre for further management as per the guidelines issued by directorate medical and health services, rajasthan, Jaipur.13(76.4%) patients were from rural and 4 (23.5%) were from urban area. 11(64.7%) patients had RT-PCR +ve, 6 had RT-PCR _ve, 2 did not have RT-PCR report. 15(88.7%) patients had high blood sugar at presentation mean being 315.7mg%. 9 (52.9%) developed mucormycosis during their treatment for COVID in hospital. 8(47.05%) presented in OPD. 9 patients had treatment with inhalational Owhile 8 patients did not have treatment with O Death rate was high (70.5%) among our patients. Patients who survived (29.4%) had only initial symptoms and signs at presentation therefore could be managed earlier. None of our patient had vaccination for COVID. Our study was done at secondary referral centre, all the previous studies were done at tertiary referral centres; therefore it shows the course of disease mainly among rural population ; most of them presented very late and had poor outcomes. It shows the need of more awareness about COVID and mucormycosis among people especially in rural areas. High blood sugar either due to treatment with steroids or pre existing is a major risk factor for Rhino orbital mucormycosis. Being RT- PCR negative for COVID 19 does not rule out the associated possible complication of Rhino orbital mucormycosis. Early diagnosis and management remains the key factor for managing Rhino orbital mucormycosis.

The Double Gut Point: A Novel Sonographic Sign of Pneumoperitoneum

Pneumoperitoneum is a life-threatening condition, caused by hollow organ perforation. The diagnosis is often difficult, and Point-of-care ultrasound can be useful to distinguish from different conditions, and early set the indication of urgent surgery. We report a critically ill patient presented to the Emergency Department with sudden increase in upper abdominal pain and distension with a diagnosis of small bowel obstruction on ultrasound using a curvilinear probe. After repeating the ultrasound using a linear probe, two dynamic points at mesogastrium very similar to the “double lung point” seen in thoracic ultrasound was detected. This “double gut point” due to bowel ischemia and perforation was confirmed on a computed tomography scan. In this case, the finding of an abdominal “double gut point” allowed us to diagnose pneumoperitoneum, being a novel sign not previously described, that could aid to diagnose small amounts of free air in the peritoneal cavity.

Photorespiration Alleviates Photoinhibition of Photosystem I under Fluctuating Light in Tomato

Fluctuating light (FL) is a typical natural light stress that can cause photodamage to photosystem I (PSI). However, the effect of growth light on FL-induced PSI photoinhibition remains controversial. Plants grown under high light enhance photorespiration to sustain photosynthesis, but the contribution of photorespiration to PSI photoprotection under FL is largely unknown. In this study, we examined the photosynthetic performance under FL in tomato (Lycopersicon esculentum) plants grown under high light (HL-plants) and moderate light (ML-plants). After an abrupt increase in illumination, the over-reduction of PSI was lowered in HL-plants, resulting in a lower FL-induced PSI photoinhibition. HL-plants displayed higher capacities for CO2 fixation and photorespiration than ML-plants. Within the first 60 s after transition from low to high light, PSII electron transport was much higher in HL-plants, but the gross CO2 assimilation rate showed no significant difference between them. Therefore, upon a sudden increase in illumination, the difference in PSII electron transport between HL- and ML-plants was not attributed to the Calvin–Benson cycle but was caused by the change in photorespiration. These results indicated that the higher photorespiration in HL-plants enhanced the PSI electron sink downstream under FL, which mitigated the over-reduction of PSI and thus alleviated PSI photoinhibition under FL. Taking together, we here for the first time propose that photorespiration acts as a safety valve for PSI photoprotection under FL.

Regulation of Leaf Angle Protects Photosystem I under Fluctuating Light in Tobacco Young Leaves

Fluctuating light is a typical light condition in nature and can cause selective photodamage to photosystem I (PSI). The sensitivity of PSI to fluctuating light is influenced by the amplitude of low/high light intensity. Tobacco mature leaves are tended to be horizontal to maximize the light absorption and photosynthesis, but young leaves are usually vertical to diminish the light absorption. Therefore, we tested the hypothesis that such regulation of the leaf angle in young leaves might protect PSI against photoinhibition under fluctuating light. We found that, upon a sudden increase in illumination, PSI was over-reduced in extreme young leaves but was oxidized in mature leaves. After fluctuating light treatment, such PSI over-reduction aggravated PSI photoinhibition in young leaves. Furthermore, the leaf angle was tightly correlated to the extent of PSI photoinhibition induced by fluctuating light. Therefore, vertical young leaves are more susceptible to PSI photoinhibition than horizontal mature leaves when exposed to the same fluctuating light. In young leaves, the vertical leaf angle decreased the light absorption and thus lowered the amplitude of low/high light intensity. Therefore, the regulation of the leaf angle was found for the first time as an important strategy used by young leaves to protect PSI against photoinhibition under fluctuating light. To our knowledge, we show here new insight into the photoprotection for PSI under fluctuating light in nature.

What impact have Covid-19 pandemic on number of death occurring at the Emergency Department: A Retrospective Analysis of Mortality in India from January 2019 to May 2021

BackgroundAcute treatment in emergency case management is required for survival and stabilization of critical patients, followed by a shifting to the relevant medical department for further care. However, for the seriously ill critical patients, i.e., when the care provided by the Emergency Department (ED) of the hospital is not enough to enable transfer, death may occur while treatment in the emergency department. This aspect of emergency management is often overlooked, and very few researcher and government is really serious regarding who dies in the ED. Aim and ObjectiveThe aim of my study was to determine the total Mortality occurring in India from 1st January 2019 to 31st May 2021(limitation here due to data availability is limited from accredited source) of emergency department admissions of public and private health facilities. The objective is to find out if there is increase or decrease in mortality of emergency department admissions during the covid-19 pandemic era by comparing average mortality of ED per month of public, private, rural, urban health facilities before the pandemic from 1st and 2nd year of pandemic i.e. 2020 and 2021 respectively MethodsThis research study is a cross sectional retrospective analysis of the mortality occurring at the emergency department of public and private, rural, urban hospitals from 1st January 2019 to May31st 2021 with aim to find out impact of covid-19. Electronic patient records from HMIS (health management information system) of MoHFW (ministry of health and family welfare) , Government of India is collected, observed, analyzed, compared for all patients deaths occurring at Emergency Department (ED) of public and private, rural, urban health facilities (n = 452102) during the period January 2019 to May 2021. ResultsThe study results found that largest total number of death occurred in the ED during may 2021 whereas the least number of deaths occurred in February 2019 (limitation is data availability up to May 2021 from accredited sources). During the first year of the pandemic, average mortality per month (Jan2020-Dec2020) in the emergency department (ED) of rural, urban, public and private hospitals in India was 16067per month whereas before the pandemic it was 12542 per month while during second year of pandemic i.e. 2021 the average mortality increased to 21758 per month (up to May 2021).DiscussionRecently a new strain omicron has again disrupted the normal life and lockdown and other measures are being implemented by different countries to save lives. The mortality at ED are having various etiologies, clinical severity at time of admission has a direct correlation with mortality, which requires the necessity of advanced triage system. There exists a lack of proper knowledge and advanced directives in the beginning i.e. December 2019 of the covid-19 pandemic era.Conclusions Due to novel disease majority of clinicians have challenging situation as well as Emergency Medicine (EM) teams faced a sudden increase in the number of cases with limited resources. Furthermore, a lack of proper knowledge and directives may have hindered access to proper care, as witnessed in many part of the world and available in various literatures. The authors hope that this study will help global researchers as well as policy makers to promote further research and discussion into preparation methods for such pandemics to reduce patient’s risk of death in the ED. KeywordsEmergency department, Death, Covid-19, Pandemic, Health facilities,

Visco-Elastic Properties of Semi-Solid Alloys

Oscillation and creep experiments have been performed with Semi-Solid Material (SSM) AlSi7 with 35% solid fraction to investigate the early visco-elastic properties after shearing of the material in a Searle Rheometer. The preparation of the SSM has been done in situ using a standard procedure to guarantee for all experiments the same initial properties of the material. First, oscillation experiments at low amplitude allowed to study the evolution of material structure with time. Subsequently, creep experiments have been performed changing the resting period based on previous results. Creep experiments are characterized by exposing the material to a sudden increase of shear stress. The resolution in time has been 0.01 seconds, which allows observing the dynamics of the development of visco-elastic properties.The material exhibits viscoelastic properties that are becoming more pronounced with longer resting time. This is in accordance with previous experiments where the ratio between elastic and viscous properties increases with increasing resting time. The development of the elastic properties follows the increase of the yield stress due to the creation of an internal structure of the material, which starts immediately after stopping shearing. The investigation of the short-term response of SSM can be particularly relevant for industrial practice, where material deformation during die filling is very fast and the material flow does not take place in steady-state condition.

The Coupling between Voltage Profiles and Mechanical Deformations in LAGP Solid Electrolyte During Li Plating and Stripping

Chemo-mechanical degradation at the solid electrolyte – Li metal electrode interface is a bottleneck to improve cycle life of all-solid state Li-metal batteries. In this study, in operando digital image correlation (DIC) measurements provided temporal and spatial resolution of the chemo-mechanical deformations in LAGP solid electrolyte during the symmetrical cell cycling. The increase in strains in the interphase layer was correlated with the overpotential. The sudden increase in strains coincides with the mechanical fracture in LAGP detected by Micro CT. This work highlights the mechanical deformations in LAGP / Li interface and its coupling with the electrochemical behavior of the battery.

Use of Plastic Waste in Bitumen

There has been a sudden increase in population and in the establishment of different industries due to which we are having waste pollution problems, including plastic waste. Discarding of plastic waste is a major problem, as it is non-biodegradable. When we mix plastic waste with bitumen, we are able to enhance bitumen's physical properties for a specific road mix. Then, bitumen's stability and water resisting capacity is upgraded. Plus, it acts as a more superior binding material than without the addition of plastic waste. Through this work, we are able to find the optimum percentage of bitumen to be substituted with plastic waste. This will also act as a part of smart waste disposal in smart cities and improve the air quality with increase environmental, economic parameters of the place leading to the improvement in human health in urban areas.

Medical Students’ Mental Health Status and Coping Strategies in Their Quarantine Period During COVID-19 Pandemic in Universiti Putra Malaysia

Movement control order (MCO) was enforced by the Malaysian government on 18th March 2020 due to sudden increase in the cumulative number of COVID-19 cases. University students, including medical students, were among the group of the population which were significantly affected. This study was conducted among medical students in Universiti Putra Malaysia (UPM) to compare the mental health status and coping strategies, between gender and phase of the clinical study related to their quarantine status between 18th March 2020 to 9th June 2020. This was a cross-sectional study involving the undergraduate medical students in UPM in the academic year of 2019/2020 during the MCO. A stratified random sampling method was used; a total of 173 respondents which includes students of Year 1 to Year 5 participated. The study was conducted after five months since the first day of MCO, for one week period of data collection. The mental health status was assessed using Depression, Anxiety and Stress Scale 21-item (DASS-21) questionnaire. Four-point Likert scale was scored to determine the degree of severity. The coping strategies was assessed using Brief-COPE (Coping Orientation to Problems Experienced) in which four-point Likert scale was used as well, and the total marks were grouped into four coping strategies. This study found higher scores of DASS-21 in the non-quarantined group and approach method was considered as a favourable coping strategy in both groups. In the quarantined group, female and clinical students showed higher scores of DASS-21. In the non-quarantined group, clinical students showed a significantly higher score of stress while male students significantly used their humour as coping strategies.

Perioperative Anesthetic Management in Preterm 12 Days Infants with Giant Meningoencephalocele at Mid Occipital and Secondary Trigonocephaly

Introduction: A meningoencephalocele is herniation of neural element along with meninges through a congenital defect in cranium. The incidence of encephalocele is approximately 1/5000 live births; occipital encephalocele is more common in females than males. It is called as giant meningoencephalocele when the head is smaller than the meningoencephalocele. These giant meningoencephaloceles harbor a large amount of cerebrospinal fluid (CSF) and brain tissue, so there occur various surgical challenges and anesthetic challenges in positioning and intubation. Case: A 12 days neonate was consulted to the neurosurgery department with complaints of large swelling over the back of head and difficulty in feeding. She was diagnosed with ventriculomegaly and meningoencephalocele since 32-33 pregnancy. The swelling was small at the time of birth, but it gradually increased in size. The child was born by section caesarean because of fetal distress and meningoenchepalocele. The neonate current weight was 3.195 grams with Post Conceptional Age (PCA) 35-36 weeks. On examination, the patient large spherical swelling was present over occipital region and there was no head control. The patient was active, conscious with no impression of focal neurological deficit. Systemic examination was unremarkable. The head circumference was 30 cm and circumference of occipital swelling was 40 cm. Potential problems in this patient include preoperative preparation and optimization of general condition, difficulty in positioning the patient, difficult airway (intubation), periodic apnea and potential hemodynamic disturbances and a sudden decrease in intracranial pressure during cele resection. Conclusion: Perioperative management in this case started from preoperative to postoperative evaluation. Preoperative preparation in anticipation of airway difficulties and communication with the operator is very important. Appropriate anesthetic techniques should aim to maintain stable hemodynamics and oxygenation and prevent a sudden increase or decrease in intracranial pressure.