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.

Covid-19 and Diabetes Mellitus a Serious Concern for the Covid -19 Patients: A Brief Review

Diabetes mellitus a group of metabolic disorders in which a person has high blood sugar, either because the pancrease does not produce enough insulin or because cells do not respond properly to the insulin that is produced. Coronavirus disease (Covid -19) recently emerged with formidable infectivity and high mortality. Emerging data suggest that diabetes is one of the most prevalent comorbidities in patients with covid -19, although casual relationship has not been investigated , where as pre existing diabetes can be considered as a risk factor for the adverse outcome of covid -19 .The present article discussed the literature related to the corelation between diabetes and covid -19.

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HISTORY OF DISTILLATES AND MEDICINAL PLANTS AND THEIR PROPERTIES

The first use of medicinal plants in the Middle East dates back to the Paleolithic. Travelers and merchants introduced the Greek and Roman treatments to Chinese and Indian physicians, who mixed and practiced these practices with their own. But later, with the establishment of the Cru-sades, Greek (Islamic) medicine also found its way to European medicine. It should also be said that the production of sweat, including rose and rose-making in Iran is very old and has many us-es, such as rose water to perfume people They used it and used it for cooking food and sweets (halva, rice sweets, yellow flakes, minced stew, rice milk) and also used other distillates, for ex-ample, mint juice was mixed with slices of lemon and in summer They were used to prevent heat-stroke and quench thirst, but today these healthy and natural drinks have been forgotten and re-placed by carbonated drinks that eventually cause obesity, high blood sugar and tooth decay. How good it is to live in a time of modern and industrial escape from the lives of our ancestors who lived healthy and without the worries of various diseases.

Fasdhu therapy to reduce excess levels of substances in the human body

Tarai Bangun Hamlet IV, Tarab Mulya Village is a village located in Kampar Regency where the majority of the people come from the Minang and Javanese tribes. They like to eat fatty foods that trigger an increase in body fat levels. This service is carried out with the aim of helping people who experience high blood sugar, cholesterol and uric acid levels with the phlebotomy technique (fasdhu). The method used is to provide health education, followed by checking blood sugar, cholesterol and uric acid. High levels are then performed Fasdhu. Based on the examination of blood sugar, cholesterol and uric acid checks on 37 respondents, it was found that 10 respondents had high levels. Fasdhu treatment was carried out on respondents who had blood sugar levels of 163 mg/dl, cholesterol 240.75 mg/dl and uric acid 8.95 mg/dl. After fasdhu treatment, the levels decreased to 107 mg/dl, 200 mg/dl and 7.15 mg/dl, respectively. Based on this treatment, it was concluded that the phlebotomy technique (fasdhu) could be recommended as an effort to reduce blood sugar, cholesterol and uric acid levels.

STUDY OF VARIOUS RISK FACTORS AND CLINICAL SITE INVOLVEMENT IN MUCORMYCOSIS PATIENT

Mucormycosis occurs commonly in immunsuppresant patients but after covid 19 pandemic there are sudden raise in mucormycosis cases.In this study we are assessing multiple risk & conditions which are probably responsible for mucormycosis epidemic.After getting various risk factors like high blood sugar,oxygen therapy,corticosteroid use we can use this data for better management of covid 19 &reduce risk for getting post covid mucormycosis.

CLINICAL STUDY TO EVALUATE EFFECT OF MUSTADI KWATH IN MADHUMEHA

The dissertation is entitled “Clinical study to evaluate the effect of Mustadi kwath in Madhumeha. Diabetes mellitus has become a dreadful disease in the era. It is also described in Ayurvedic text in terms of Madhumeha. Diabetes Mellitus is a group of metabolic disease in which there are high blood sugar levels over a prolonged period, this high blood sugar produces the symptoms of frequent urination, increased thirst, and increased hunger. Untreated, diabetes can cause many complications. Sedentary lifestyle, lack of exercise, improper medication and urbanization precipitates the disease. In the present study, Mustadi kwath (mentioned in Bhaisjya Ratnawali) was selected for clinical trial. The study comprises of 40 patients of Madhumeha. These patients were randomly selected on the basis of inclusion and exclusion criteria with detailed clinical history, physical examination and other desired investigation. The duration of study is of 90 days with 15 days follow up. After evaluating therapy it was observed that the ‘Mustadi kwath’ provided better relief to the patients of Madhumeha.

The Centenary Celebrations-Insulin and Diabetes.

Most people will know the word diabetes. Few people will not know it has something to do with sugar. Diabetes mellitus is the complete name for the condition, mellitus meaning sweet or honey taste found in the urine. Not to be confused with Diabetes insipidus, a condition of the pituitary gland, the kidney or the Psyche where water cannot be retained by the body and very severe thirst and huge polyuria (passing a huge amount of urine occurs). The condition Diabetes mellitus was known in Egyptian times and in recent times has become so much more prevalent. Alas most people will have a relation with the condition and will be aware that complications can occur such as blindness. Even today with all our new medications and all our new knowledge, still diabetes shortens life span by 10 or so years but this figure is rapidly getting less due to earlier diagnosis and better treatment for high blood sugar, cholesterol and high blood pressure. To go back more than 100 years obese patients who developed diabetes could cure the symptoms which include thirst, passing a lot of urine, tiredness and genital itch by weight reduction and exercise. The reason for this improvement is now known in much more detail than it was then. The hormone insulin which is secreted by the islet cells in the pancreas lowers blood sugar. A deficiency of insulin leads to a rising blood sugar and the high blood sugars are the cause of the thirst. The high blood sugar is no longer able to be contained by the kidney and is secreted in the urine. The high concentration of sugar in the urine pulls out sugar by osmosis, drags with it, water, so the higher the glucose in the blood and urine the more water is pulled through the kidneys which are filters. The increased amount of water thus lost, results in frequency of passing water which is now full of glucose. The loss of water is recognised by the thirst mechanism which gets switched on and being very thirsty the patient with diabetes starts to drink and drink to make up for the loss of water in the urine. Sometimes the patient who might have been keen on lemonade or other sweet drinks just drinks more and more not realising that the drinks are heavily laden with sugar. This results in increasing the blood sugar even higher and even more thirst until the whole system collapses. The patient becomes unconscious very dehydrated and will die unless given intravenous fluids and then insulin. One such lady was a patient of mine. The African lady was so complicated that after she recovered we wrote up her case in one of the medical journals to inform others of the problems we faced and the treatments we gave which resulted in her recovery. Hyperosmolar coma is the name of the condition and thankfully rare. I can of course remember other patients who we were not successful in saving but they are too painful to relate.

Prevalence and Correlates of Microalbuminuria among Type 2 Diabetes Patients at Muhimbili National Hospital, Dar es Salaam, Tanzania

Background Regular screening for microalbuminuria among type 2 diabetes patients is less common in most low-income countries while it is an early marker of diabetic nephropathy and cardiovascular complications. Objective This study aims to assess the need for regular screening for microalbuminuria among type 2 diabetes patients. Methodology with cross-sectional approach, 124 diabetic patients were recruited at Muhimbili National Hospital, in Tanzania; their age, gender, body mass index, fasting blood sugar levels (by Accu Chek Active Glucometer), random urine albumin levels (by Microalbumin 2-1 Combo Test Strips), and the duration of diabetes were recorded. Results The study indicated that 62.1% of the participants were microalbuminuric while 2.4% were macroalbuminuric. The risk of microalbuminuria was 4.55 higher in patients aged 60-69 years (95% CI: 1.32-16.51), and 17.4 times higher in patients aged 70 and above (95% CI: 1.49-202.86) compared to individuals aged below 50 years. Patients with high blood sugar level had a risk of 8.09 times higher compared to those with normal blood sugar (CI: 2.53-25.86). Also, the odds were 7.89 higher in patients who lived with diabetes for 10-14 years compared to those lived with the disease less than 5 years (95% CI:1.33-45.59). Conclusion The odds of microalbuminuria increased significantly as the patient gets older, with high blood sugar, and the duration of diabetes. Health policies need to establish programs that enhance care at the diabetic clinic through regular screening for microalbuminuria to reduce the risk of developing kidney and cardiovascular complications. Rwanda J Med Health Sci 2021;4(1):84-97