Oesophageal candiasis in AIDS

With the explosion in the number of AIDS patients, many of these are likely to consult to otolaryngologists the head & neck is a rather common site to be affected. Sometimes only oesophageal candidiasis is the presenting feature as in the present case which is being reported show typical radiological appearance. the differential diagnosis and treatment of nesophageal candidiasis is briefly discussed     

Oesophageal foreign body in four month old infant

A 4 month old male infant was brought with only strong suspicion of foreign body ingestion without any symptomatology. X-ray examination revealed foreign body at cricopharyngeus, which was managed successfully emphasizing the fact that a strong suspicion and relevant radiography is the key to early and successful management.     

Alcohol use among physicians in a medical school in Nepal

Objective: The objective of the study was to know about the use of alcohol among physicians and factors that were related to it. Methods: This was a cross sectional study conducted among the physicians in a medical school of eastern Nepal. A semi structured questionnaire was used to collect information. Results: There were 55 subjects in the study. Half of them were between 35-45 years age group and one fourth among them were female. There were more than 88% physicians consuming alcohol for more than 10 years. One third used to preferred whisky as their favorites drink. Use of alcohol among them was due to peer pressure and to become a social human being. Most of them drink alcohol occasionally with an average amount 30-60ml in a sitting and usually in the evening. Most of the time, they use alcohol either in parties or at home. Conclusion: Alcohol use in Nepal is very much prevalent. The use of alcohol is socially accepted in many communities. Uses of alcohol by physicians have direct effect on their health as well as the health of many people because they are role model for many people. They are also in direct contact with the patients. Steps to council the physicians may reduce the consumption of alcohol. Key words: Alcohol, Nepal, Physicians, Dependence, Abuse.     

Associations of Emergency Department Visits for Asthma with Precipitation and Temperature on Thunderstorm Days: A Time-Series Analysis of Data from Louisiana,USA, 2010–2012

Background: Studies of thunderstorm asthma to understand risk factors using high-resolution climate data and asthma outcomes on a large scale are scarce. Moreover, thunderstorm asthma is not well studied in the United States.Objectives: We examined whether climate parameters involved in thunderstorms are associated with emergency department (ED) visits for acute asthma attacks in the United States.Methods: We analyzed 63,789 asthma-related, daily ED visits for all age groups, and thunderstorm-associated climate data in Louisiana during 2010 through 2012. We performed time-series analyses using quasi-Poisson regression models with natural cubic splines of date, parish, holiday, day of week, season, daily maximum concentrations of ozone (O3) and fine particulate matter [PM ≤2.5μm in aerodynamic diameter (PM2.5)], and daily mean pressure, precipitation, and temperature. Because of a significant interaction effect between temperature and lightning days on asthma-related visits, we performed stratified analyses by days with/without lightning or thunderstorm (defined by any lightning and precipitation).Results: On thunderstorm days, higher asthma-related ED visits were associated with higher daily mean precipitation [relative risk (RR)=1.145 per 1g/m2/s (95% CI: 1.009, 1.300)] and lower daily mean temperature [RR=1.011 per 1°C change (1.000–1.021)] without carry-over effect to the next non-thunderstorm day. These higher risks were found mainly among children and adults <65 years of age. We observed similar results on lightning days. However, we did not find similar associations for non-thunderstorm or non-lightning days. Daily maximum O3 and PM2.5 levels were not significantly associated with asthma ED visits on thunderstorm days.Discussion: Higher precipitation and lower temperature on thunderstorm days appear to contribute to asthma attacks among people with asthma, suggesting they should consider taking precautions during thunderstorms. EDs should consider preparing for a potential increase of asthma-related visits and ensuring sufficient stock of emergency medication and supplies for forecasted severe thunderstorm days. https://doi.org/10.1289/{"type":"entrez-protein","attrs":{"text":"EHP10440","term_id":"372009825","term_text":"EHP10440"}}EHP10440     

Analysis of COVID-19-associated rhino-orbital-cerebral mucormycosis patients in a tertiary care center in Northern India

Purpose:An unprecedented surge has been noted in rhino-orbital-Cerebral mucormycosis (ROCM) in times of current COVID-19 pandemic. The present prospective study aims to evaluate clinico-epidemiological profile, risk factors, management, and outcome of the cases of ROCM that presented to our tertiary care center during the study period from April to June 2021.Methods:All patients were subjected to complete history taking, ophthalmological examination, and imaging studies. The patients were staged and were treated with intravenous liposomal amphotericin B (AMB) and sino-nasal debridement of local necrotic tissue. Transcutaneous retrobulbar AMB (TRAMB), orbital decompression, and exenteration were instituted as indicated. All patients were followed up for a minimum of 6 months before arriving at the final outcome. Statistical analysis was performed.Results:A total of 49 patients presented during the study period, with a mean age of 42.2 years. The major risk factors included uncontrolled diabetes (89.8%), COVID-19 positivity (51.02%), and concurrent steroid use (38.77%). The most common presenting symptom was facial pain/swelling (43.65%), while the most common presenting sign was deterioration in vision (75.51%). Intravenous liposomal AMB was given to all patients along with sino-nasal debridement (85.71%), TRAMB (57.14%), orbital decompression (14.28%), and exenteration (12.24%). Overall, mortality at 6 months was 22.45% (11 patients). Age more than 60 years, intracranial extension, and HbA1c of more than 8.0% were observed to be statistically significant indicators of mortality.Conclusion:Early suspicion and timely diagnosis of mucormycosis at rhino-orbital stage is warranted in order to salvage life as well as visual function. TRAMB may prove as potentially favorable treatment modality in cases with limited orbital involvement.     

Modulation of biliverdin dynamics and spectral properties by Sandercyanin

Biliverdin IX-alpha (BV), a tetrapyrrole, is found ubiquitously in most living organisms. It functions as a metabolite, pigment, and signaling compound. While BV is known to bind to diverse protein families such as heme-metabolizing enzymes and phytochromes, not many BV-bound lipocalins (ubiquitous, small lipid-binding proteins) have been studied. The molecular basis of binding and conformational selectivity of BV in lipocalins remains unexplained. Sandercyanin (SFP)–BV complex is a blue lipocalin protein present in the mucus of the Canadian walleye (Stizostedion vitreum). In this study, we present the structures and binding modes of BV to SFP. Using a combination of designed site-directed mutations, X-ray crystallography, UV/VIS, and resonance Raman spectroscopy, we have identified multiple conformations of BV that are stabilized in the binding pocket of SFP. In complex with the protein, these conformers generate varied spectroscopic signatures both in their absorption and fluorescence spectra. We show that despite no covalent anchor, structural heterogeneity of the chromophore is primarily driven by the D-ring pyrrole of BV. Our work shows how conformational promiscuity of BV is correlated to the rearrangement of amino acids in the protein matrix leading to modulation of spectral properties.

Biliverdin IX-alpha undergoes rotation around the D-ring pyrrole and displays a broad far-red absorbance on binding to monomeric Sandercyanin variant (orange) compared to the wild-type tetrameric protein (cyan).     

Objective assessment of the human visual attentional state

Primary objective

The purpose of this study was to develop an objective way to assess human visual attention using the alpha-band component of the visual-evoked potential (VEP).

Design and methods

Six different attentional conditions were tested: eyes-open, eyes-closed, eyes-closed with backwards number counting, and three rapid-serial visual presentation (RSVP) tasks. Eighteen visually normal, young-adult subjects (ages 21–28 years) were tested binocularly at 1 m for each condition on two separate days. The Diopsys? NOVA-TR system was used to obtain the visual-evoked potential (VEP) and extracted alpha wave and its related power spectrum. Additionally, the Visual Search and Attention Test (VSAT) was administered as a subjective measure of visual attention.

Results

Subjects exhibited significant decreases in power in the alpha band when comparing the eyes-closed with the eyes-open conditions, with power in the eyes-closed condition being, on average, twice as large. The response from the other four conditions did not reflect the differential attentional demands. The ratio of the power in the eyes-closed condition to the eyes-open condition in the lower-alpha frequencies (8–10 Hz) was found to be significantly correlated with the group’s performance on the VSAT, especially the 10-Hz component.

Conclusions

An individual’s ability to attenuate their alpha component during visual processing may be a predictor of their visual attentional state. These findings solidify the role of the VEP alpha subcomponent as an objective electrophysiological correlate of visual attention, which may be useful in the diagnosis and treatment of human visual attention disorders in the future.     

Novel association of VACTERL,neural tube defect and crossed renal ectopia – Sonic hedgehog signaling: A point of coherence?

The present case report describes two patients with a novel combination of VACTERL (vertebral, anorectal, cardiac, tracheoesophageal, renal, limb), neural tube defect and crossed renal ectopia. Though cases of VACTERL associated with crossed renal ectopia have been described, the present case report is the first to describe its combination with neural tube defect. The cases reported here are significant because central nervous system manifestations are scarce in VACTERL syndrome. The role of sonic hedgehog pathway has been proposed in VACTERL association and neural tube defects. Axial Sonic hedgehog signaling has also been implicated in the mediolateral positioning of the renal parenchyma. With this knowledge, the etiopathogenesis of this novel combination is discussed to highlight the role of sonic hedgehog signaling as a point of coherence.