COVID-19-associated mucormycosis and treatments

In the current pandemic, COVID-19 patients with predisposing factors are at an increased risk of mucormycosis, an uncommon angioinvasive infection that is caused by fungi with Mucor genus which is mainly found in plants and soil. Mucormycosis development in COVID-19 patient is related to various factors, such as diabetes, immunocompromise and neutropenia. Excessive use of glucocorticoids for the treatment of critically ill COVID-19 patients also leads to opportunistic infections, such as pulmonary aspergillosis. COVID-19 patients with mucormycosis have a very high mortality rate. This review describes the pathogenesis and various treatment approaches for mucormycosis in COVID-19 patients, including medicinal plants, conventional therapies, adjunct and combination therapies.     

Make in India: Normative data for automated perimetry

Background:The normative data set in authomated perimetry is predominantly of non-Indian origin and hence may not be an accurate basis for visual field analysis in Indian population. This video describes an attempt to create a native normative dataset for automated perimetry, which can then be fed in our machines and be used as the normative database.Purpose:To formulate normative data and to increase domain knowledge of normative values for automated perimetry in Indian population of different age groups.Synopsis:Cross-sectional study conducted on patients receiving outpatient care in a span of 3 years, which included 6586 healthy normal patients (13172 eyes) with vision 6/6 unaided or after refractive correction. The patients were tested with 30-2 SITA FAST threshold algorithm on Humphrey Field Analyzer Model no: 745i. Normative data was calculated on basis of age group ranging from 19-75 years categorized to every decade. Normal values were formulated on basis of perimetry performed on normal patients.Highlights:Our work on creating a native normative dataset may add value as well as increase the accuracy of perimetry analysis in Indian eyes.Online Video Link: https://youtu.be/jqgC2Tn7HIg     

Laparoscopic total radical hysterectomy by the Pune technique: our experience of 248 cases

STUDY OBJECTIVE: To describe our experience and technique of total laparoscopic radical hysterectomy with pelvic lymphadenectomy, which is the largest single- institution study. DESIGN: Retrospective, nonrandomized study (Canadian Task Force classification II-2). SETTING: Private hospital. PATIENTS: Two hundred forty-eight patients with International Federation of Gynecology and Obstetrics stage IA2 (n = 32) and IB1 (n = 216) of cancer of the cervix. INTERVENTION: Total laparoscopic type III radical hysterectomy with bilateral pelvic lymphadenectomy was done. Simple repetitive steps were used to perform this surgery and develop an easily replicable technique. Harmonic Shears, bipolar coagulation, and vascular clips were used. Resection of the cardinal and uterosacral ligaments was performed with LigaSure (LigaSure Vessel Sealing System; Valleylab, Tyco Healthcare, Boulder, CO) or the Harmonic Shears (Ethicon Endo-Surgery, Inc., Cincinnati, OH). Pelvic lymph node dissection was done. MEASUREMENTS AND MAIN RESULTS: Histopathologically, there were 183 (73%) cases of squamous carcinoma, 52 (20%) adenocarcinomas, and 13 (5%) adenosquamous carcinomas. Four patients needing anterior exenteration because of bladder involvement were excluded from data analyses. The operation was performed entirely by laparoscopy in all patients and by the same surgical team. The patients' median age was 61 years. The median operative time was 92 minutes (range 65-120 minutes). The median number of resected pelvic nodes was 18. The median blood loss was 165 mL. The median length of stay was 3 days. All 15 intraoperative complications were tackled laparoscopically. No patients were converted to the open technique. There were no deaths in our series. Seventeen patients had complications within 2 months of surgery. Seven patients had recurrences after a median follow-up of 36 months. CONCLUSION: Our technique of total laparoscopic radical hysterectomy, developed over 248 cases, can be performed safely. It is an easily replicable technique. This procedure reduces the morbidity associated with abdominal radical hysterectomy. All of the complications can also be tackled laparoscopically, which does not further add to the morbidity.     

Resting Energy Expenditure and Systolic Blood Pressure Relationships in Women Across 4.5 Years

Recent studies have reported a strong association between blood pressure (BP) and resting energy expenditure (REE). However, it is not known whether this relationship persists over time. Therefore, the authors examined the temporal relationship between REE and systolic BP. In addition, the impact of sympathetic tone and anthropometric variables on this relationship was examined. All testing was performed on healthy, overweight African American and European American women aged 25 to 45 years over 4.5 years in the University of Alabama at Birmingham General Clinical Research Center. Repeated‐measures mixed‐models revealed REE as a significant determinant of systolic BP (β=0.0155, P<.0001), independent of catecholamines, leg fat, visceral fat, fat‐free mass, fat mass, height, relative skeletal muscle index, and resting heart rate. Observations that REE is predictive of systolic BP across 4.5 years support previous findings that REE may potentially mediate resting BP, independent of anthropometric variables and a marker for sympathetic tone.     

Medical Research Misconduct Need Regulatory Reforms

The medical research misconduct has become a global problem. Except from countries like the USA, China, and Germany the exact figures of misconduct are not available. The research misconduct include fabricating the data, falsifying data, and plagiarism. The irresponsible research practices are publishing research data more than once, conflicts of interest is not declared, selective reporting of data and including an author who has not contributed at all and many more. About 2% of scientists have been found to admit the fabricating the data and 33% researchers were involved in irresponsible research practices. There is no formal regulatory programs available to monitor the research projects. Few developed countries like the USA, Germany, and China tried to develop programs which can monitor the medical research misconduct. There is a need to develop a regulatory system at national and institutional level to regulate the research activity to ensure that good ethical and scientific standards are practiced by medical researchers.     

The Impact of Comprehensive Care for Joint Replacement Bundled Payment Program on Care Delivery

Background

Comprehensive Care for Joint Replacement (CJR) is a Medicare initiative to test the impact of holding a hospital accountable for services provided during an episode of care for a lower extremity joint arthroplasty on costs and quality. This study examines whether hospital participation in CJR is associated with having programs focused on improving posthospitalization care or reducing costs using a survey of orthopedic surgeons.