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

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

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

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.

PULMONARY FUNCTION PARAMETERS IN TYPE 2 DIABETES MELLITUS AND NON DIABETIC POPULATION IN A SUBURBAN AREA OF TAMILNADU -A COMPARATIVE STUDY

Diabetes Mellitus has a profound incidence all over the world .Complications of diabetes like nephropathy ,neuropathy and retinopathy were well known while changes in the lung as a result of diabetes were with limited information. Methods: About 175 participants with diabetes and 168 non diabetic participants were tested for pulmonary functions using a computerisied spirometer. Pulmonary functions of the two groups were compared using t test . Results: FVC (Forced vital capacity) of diabetic 58.59% while non diabetic it was77.16 %. MMEF(Maximum mid expiratory ow rate) of diabetic was 61.36% while non diabetic it was 90.13%FVC (Forced vital capacity in 3 seconds ) was 31.96% while in diabetic it was 2.76 liters. PEF (Peak expiratory ow rate ) of diabetic was 41.95% while non diabetic it was 68.30%.Conclusion:The pulmonary functions were grossly decreased in Type2 Diabetes mellitus when compared with non diabetic subjects

AWARENESS ABOUT DIABETIC RETINOPATHY AMONG THE PATIENTS (TYPE1 & TYPE2 DIABETES MELLITUS) ATTENDING A TERTIARY EYE CENTRE IN WEST BENGAL

INTRODUCTION: Diabetes Mellitus is a major public health concern worldwide. Global burden of diabetes is increasing at an alarming rate. The lack of awareness among population is the major cause of the disease burden as well as its complications. According to the Global Burden Disease Study, the prevalence of diabetes mellitus (DM) in India was 31.7 million in the year 2010, and the prevalence is expected to upsurge to 79.4 million 1 by the year 2030. AIMS AND OBJECTIVES:To assess the awareness level of Diabetic Retinopathy among the diabetic individuals. To increase the level of awareness regarding one of the leading causes of blindness among population and thereby minimizing the sight threatening complication of Diabetes. METHODOLOGY Study design/ Experiment design:Institution based cross-sectional study. Study setting and timelines:All patients who fulll the inclusion criterias, presented to the Out Patient Department of RIO, Kolkata in a time span of 18 months were taken for study with their informed consent. Apre-tested interviewer-administered KAPquestionnaire was asked to the patients. Eyes were examined by slit lamp biomicroscope, detailed posterior segment examination by +90D lens and indirect ophthalmoscope to detect diabetic retinopathy. Period of study:January 2019 - June 2020 Study population: 200 patients RESULT AND ANALYSIS:We found in Knowledge about DR Present, 7(21.2%) patients were Female and 26(78.8%) patients were Male. Association of Gender vs Knowledge about DR was statistically signicant (p=0.0017). In Knowledge about DR present, 4(12.1%) patients had DM 1 and 29(87.9%) patients had DM 2. Association of Type of DM vs Knowledge about DR was statistically signicant (p<0.0001). SUMMARYAND CONCLUSION:In Knowledge about effect of DM on eyesight present, 119(90.8%) patients were having duration of diabetes for 10-20yrs and 12(9.2%) patients were having duration >20yrs which was statistically signicant. It was found that Education Level was signicantly associated with Knowledge about effect of DM on eyesight as well as with Knowledge about Diabetic Retinopathy. 33(25.2%) patients had both Knowledge about DR and Knowledge about effect of DM on eyesight. Association of Knowledge about DR with Frequency of eye check-up was statistically signicant

Circulating levels of asprosin and its association with insulin resistance and renal function in type2 diabetes mellitus and diabetic nephropathy patients

Introduction : Adipokines have an important role in development and progression of type 2 diabetes mellitus (T2DM) and its complications such as nephropathy. Asprosin is a recently discovered adipokine that involve in glucose metabolism and inflammation process. The present study sought to evaluate asprosin levels in patients with T2DM and T2DM + nephropathy (NP) compared to controls and its relation with markers of insulin resistance, inflammation and renal function. Methods Serum levels of asprosin, adiponectin, IL-6 and TNF-α were measured in 55 control, 54 T2DM and 55 T2DM + NP patients using ELISA kits. Results Asprosin was found to be higher in T2DM (6.73 ± 1.67) and T2DM + NP (7.11 ± 1.54) compared to controls (4.81 ± 1.09) (p < 0.001), while adiponectin indicated a lower concentration in both patient groups compared with controls. Moreover, IL-6 and TNF-α indicated higher levels in both patients group compared with controls. Asprosin indicated a positive correlation with HbA1c, FBG, TC, LDL-C, IL-6 and TNF-α in T2DM group. In the patients with T2DM + NP asprosin positively correlated with BMI, HbA1c, insulin, HOMA-IR, Cr, UAE, IL-6 and TNF-α and inversely correlated with eGFR. Conclusion Higher concentration of asprosin in T2DM and T2DM + NP and its relation with glucose and lipid metabolism, and markers of renal function and inflammation suggested a possible role for this adipokine in the pathogenesis of T2DM and nephropathy.

EFFICACY OF PRANAYAMIC BREATHING ON COGNITION AND INSTRUMENTAL ACTIVITIES OF DAILY LIVING IN TYPE2 DIABETES MELLITUS.

Type 2 diabetes is inherent in poor physical performance and cognitive functions that affect patients' overall performance in their activities of daily living (ADL) (Lindsay et al., 2016) . Diabetes and cognitive dysfunction are linked, according to epidemiological evidence. When compared to adults without type 2 diabetes, adults who develop type 2 diabetes later in life have cognitive decits; psychomotor productivity, executive function, and learning and memory skills are often the most affected(Wrighten et al., 2009; Okereke, 2008.).So this study aims to investigate the. efcacy of pranayamic breathing on cognition and Instrumental Activities of Daily living (IADL) in type2 diabetes mellitus.(DM). Thirty type2 Diabetic patients between 45-65 years of age were selected randomly and were divided into two groups. Group A received pranayama breathing with conventional physiotherapy for 5 days a week for 4 weeks. Group B received conventional physiotherapy. Montreal cognitive assessment scale (MoCA) and Functional activities questionnaire (FAQ) were reported to determine cognition and IADL.Between group comparison of MOCAshowed that the paired difference obtained from pretest to post test in the experimental group was 3.80±0.862 and in the conventional group 1.13±0.352, the effect size was 4.05 and this observed difference was statistically signicant (p<0.001). Between group comparison of FAQ says that the paired difference obtained was 3.33±0.816 for experimental group and 1.80±1.47 for control group. The effect size observed was 1.28 and it was statistically signicant (p=0.002).The ndings of the study show that there is signicant difference between the scores of two groups which concludes , pranayama breathing with conventional physiotherapy has shown signicant improvement in cognition and Instrumental Activities of daily living among Type 2 Diabetes Mellitus..

STUDY OF THYROID FUNCTION IN TYPE 2 DIABETES MELLITUS PATIENTS OF MALWA REGION.

Background: Thyroid disorders and diabetes mellitus are two common endocrine disorders that are commonly encountered in clinical practice. The relationship between thyroid disease and diabetes is important for physicians to understand in order to provide the best treatment for both conditions. The aim of this study was to assess thyroid function in Type2 Diabetes Mellitus patients of malwa region and raise awareness about thyroid dysfunction in newly diagnosed T2DM patients. Methods: In this case control study, a total of 200 subjects were chosen. Group I consisted of 100 diagnosed type 2 diabetes cases and Group II 100 sex matched stable controls. After receiving informed consent, patients were enrolled. Thyroid dysfunction in Type2 diabetes mellitus was assessed using biochemical parameters such as fasting plasma glucose, total triiodothyronine T3, total thyroxine T4, and thyroid stimulating hormone (TSH). Results: When diabetic patients were compared to healthy controls, their fasting blood glucose and serum TSH levels were substantially higher. In these two classes, however, there was no substantial difference in serum T3 and T4 levels. The findings suggest that diabetic patients have subclinical hypothyroidism as opposed to the control group in the study population Conclusion: From this current study it has been observed that thyroid function levels were altered in Diabetes mellitus patients, especially TSH levels. so it is suggested that diabetes mellitus patients should be screened for thyroid function studies on a regular basis to prevent further complications of thyroid dysfuction. Keywords: Type 2 diabetes mellitus, Thyroid dysfunction.