Clinicopathological association of mucormycosis in COVID 19 pandemic

Context

Coinfection and superadded infections in patients with coronavirus disease 2019 (COVID-19) has been reported on multiple series. The emerging second wave of the pandemic has come with a lot of changes, especially in developing countries like India. One of such changes is sudden, significant rise in mucormycosis cases.

Aims

To find out clinicopathological association of invasive mucormycosis with COVID-19 infection status and immunocompromised state.

Settings and Design

A cross-sectional study done at a tertiary care centre.

Methods and Material

All cases admitted in the dedicated mucormycosis ward between 1-06-2021 and 15-06-2021 were included in the study. The cases were admitted with suspicion of mucormycosis. The histopathological results were correlated with KOH mount and radiological reports. The clinicopathological association of occurrence of mucormycosis in post-covid and non-COVID patients along with other risk factors.

Statistical Analysis Used

Odds ratio, chi square test were used to find the association using MS Excel 2010 and SPSS.

Results

Thirty-six (81.82%) cases were of the post-COVID status, and 8 cases were non-COVID status. Out of 36 post-COVID patients, 33 (91.67%) showed evidence of invasive mucormycosis and of 8 non-COVIDpatients, 7 had evidence of mucormycosis (odds ratio = 1.57). Out of the total diagnosed cases of mucormycosis, 21 (52.5%) patients were known cases of diabetes mellitus (DM), and 7 (17.5%) cases of newly diagnosed hyperglycemia. Thirty (75%) patients out of 40 had some form of immunocompromised state. This shows statistically significant association of DM and immunocompromised state with the occurrence of mucormycosis in post-COVID patients (chi square value² = 6.891, P value = 0.008). Twenty-five patients had the history of steroid use during the treatment of COVID-19.

Conclusions

The infection with COVID-19 definitely increases the odds of contracting mucormycosis, but most of the cases had diabetes mellitus. So, it is possible that COVID-19 virus predisposes individuals to invasive fungal infection by precipitating DM.

Psychological assessment and lived experiences of recovered COVID-19 patients who presented for convalescent plasma donation

Background

Increasingly, it has been seen that patients recovering from COVID-19 may face a second battle of coping with its mental health ramifications. These psychological issues can even be experienced by patients who were asymptomatic or had mild to moderate symptoms, potentially impacting their quality of life.

Methodology

This was a prospective observational study to analyse the psychological impact of COVID-19 in recovered patients who presented as prospective convalescent plasma (CP) donors. An interview for the psychological assessment of the prospective donors was carried out. Depression and anxiety in the participants were assessed by HAM-A, and HAM-D scores and Quality of Life were assessed using the WHOQOL-BREF scale.

Results

A total of 51 prospective donors were assessed, with a mean age of 34.37 (±9.08) years, with the majority being males (46). No clinically significant depression and anxiety were found on the basis of HAM-D and HAM-A scores. The worst affected quality of life parameter, based on the WHOQOL-BREF scale, was physical quality of life followed by environmental, psychological, and social relationships. Moreover, due to infection, social stigma was experienced by 49.02% of the donors, while 21.97% had anxiety related to convalescent plasma donation as a common livid experience.

Conclusion

Poor quality of life and social stigma during the recovery phase is prevalent in COVID-19 recovered patients, for which formulation of holistic support strategies are the need of the hour.

Warthin's tumour with coexistent tuberculosis

A 81-year-old man presented with a 2-month history of swelling of the right angle of the jaw. On histopathological examination a diagnosis of Warthin's tumour with coexistent tuberculosis of the parotid gland was made. PCR for tuberculosis was positive. Tuberculosis of the parotid gland is very rare and coexistence with Warthin's tumour is extremely rare. This case is being reported for its rarity.

Long-term changes in glutamatergic synaptic transmission in phenylketonuria

The cellular mechanisms that underlie impaired brain function during phenylketonuria (PKU), the most common biochemical cause of mental retardation in humans, remain unclear. Acute application of L-Phe at concentrations observed in the PKU brain depresses glutamatergic synaptic transmission but does not affect GABA receptor activity in cultured neurons. If these depressant effects of L-Phe take place in the PKU brain, then chronic impairment of the glutamate system, which may contribute to impaired brain function, could be detected as changes in postsynaptic glutamate receptors. This hypothesis was tested by using a combination of liquid chromatography-mass spectrometry, patch-clamp, radioligand binding and western blot approaches in forebrain tissue from heterozygous and homozygous (PKU) Pah(enu2) mice. Brain concentrations of L-Phe were nearly six-fold greater in PKU mice (863.12 +/- 17.96 micromol/kg) than in their heterozygous counterparts (149.32 +/- 10.23 micromol/kg). This concentration is significantly higher than the K(B) of 573 microM for L-Phe to compete for N-methyl-D-aspartate (NMDA) receptors. Receptor binding experiments with [3H]MK-801 showed significant up-regulation of NMDA receptor density in PKU mice. Consistent with the depressant effects of L-Phe, expression of NMDA receptor NR2A and (RS)-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid (AMPA) receptor Glu1 and Glu2/3 subunits was significantly increased, whereas expression of the NR2B subunit was decreased. There was no change in GABA alpha1 subunit expression. Given the role of the glutamatergic system in brain development and function, these changes may, at least in part, explain the brain disorders associated with PKU.

Aerosol-OT microemulsions as transdermal carriers of tetracaine hydrochloride

The aerosol-OT (AOT)/water/isopropyl myristate microemulsion was investigated as a carrier in transdermal drug delivery of tetracaine hydrochloride. The study included in vivo analgesic studies on rats and histopathological, irritation, and oxidative stress measurements on mice. The tetracaine hydrochloride encapsulated in AOT/water/isopropyl myristate showed an eightfold enhancement in the analgesic response of drug compared to the aqueous solution of the drug as measured by the tail-flick method. The analgesic response of tetracaine hydrochloride, however, highly depended on the concentration of AOT and water of the microemulsion. The preliminary histopathological, irritation, and oxidative stress studies showed that AOT/water/isopropyl myristate microemulsion system is a safe transdermal carrier of tetracaine hydrochloride with a concentration of AOT in isopropyl myristate up to 21:79 w/w.

Activity and stability of Bacillus cereus penicillinase entrapped in aerosol OT reverse micelles

The kinetics of enzyme catalyzed hydrolysis of penicillin G and stability of the enzyme alpha-penicillinase, entrapped in aerosol OT reverse micellar droplets have been investigated spectrophotometrically. Various physical parameters, such as, water pool size (related to Wo), pH and temperature, were optimized for maximum activity of penicillinase in water/aerosol OT/isooctane reverse micelles. The enzyme showed maximum activity of Wo - 14 and pH, 7.0. At any temperature the enzyme was to be more active in reverse micelles than in aqueous solution. At optimum conditions of Wo, pH and temperature the enzyme was 100% more active in reverse micelles than its maximum activity in aqueous solution. In both the systems, the activity starts falling at and above 25 degrees C. CD Spectral studies showed that the enzyme in reverse micelles possesses more helical structure than it has in aqueous solution and at the optimum conditions in which it showed maximum activity, the alpha-helicity was also maximum. The enzyme was very stable in reverse micelles at and above room temperature compared to the same in aqueous solution.