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There has been a surge of rhino-orbital mucormycosis cases in India in the wake of the second wave of the COVID-19 pandemic. It has been widely suggested that dysglycemia resulting from diabetes which is a common comorbidity in COVID-19 patients, and indiscriminate steroid use has resulted in this surge. We report a series of 13 cases of rhino-orbital mucormycosis in COVID-19 patients admitted to our center between mid-April and early June 2021. The cases showed a male preponderance, two patients had loss of vision, and four of them showed intracranial extension of disease. Twelve patients had received steroids and 12 had preexisting or newly diagnosed diabetes, both steroid use and diabetes being the most common identified risk factors. Considering other possible risk factors, immunosuppressed state, antiviral or ayurvedic (Indian traditional) medications, and oxygen therapy were not associated with a definite risk of mucormycosis, because they were not present uniformly in the patients. We propose that COVID-19 itself, through molecular mechanisms, predisposes to mucormycosis, with other factors such as dysglycemia or steroid use increasing the risk.

The pyrochlore lattice is associated with several potential and actual spin liquid phases as a result of its strong geometric frustration. At finite temperature, these can exhibit an unusually broad cross-over regime to a conventional paramagnet. Here, we study this regime analytically by showing how a single-tetrahedron Hamiltonian can extrapolate beyond the first term of a high-temperature expansion and yield insights into the build-up of correlations. We discuss how this unusual behaviour is brought about by the structure of the eigenspaces of the coupling matrix. Further interesting behaviour can appear for parameter values located near phase transitions: we find coexistence of $(111)$ rods and $(220)$ peaks in the structure factor, as observed in neutron scattering experiments on Yb$_2$Ti$_2$O$_7$., Comment: 7 pages, 4 figures

The two-dimensional Wigner crystal (WC) occurs in the strongly interacting regime ($r_s \gg 1$) of the two-dimensional electron gas (2DEG). The magnetism of a pure WC is determined by tunneling processes that induce multi-spin ring-exchange interactions, resulting in fully polarized ferromagnetism for large enough $r_s$. Recently, Hossain et al. [PNAS 117 (51) 32244-32250] reported the occurrence of a fully polarized ferromagnetic insulator at $r_s \gtrsim 35$ in an AlAs quantum well, but at temperatures orders of magnitude larger than the predicted exchange energies for the pure WC. Here, we analyze the large $r_s$ dynamics of an interstitial defect in the WC, and show that it produces local ferromagnetism with much higher energy scales. Three hopping processes are dominant, which favor a large, fully polarized ferromagnetic polaron. Based on the above results, we speculate concerning the phenomenology of the magnetism near the metal-insulator transition of the 2DEG., 4 pages + references & Supplementary (5 pages), 2+4 figures, 1 table. Minor revision based on comments

Alu retroelements propagate via retrotransposition by hijacking long interspersed nuclear element-1 (L1) reverse transcriptase (RT) and endonuclease activities. Reverse transcription of Alu RNA into complementary DNA (cDNA) is presumed to occur exclusively in the nucleus at the genomic integration site. Whether Alu cDNA is synthesized independently of genomic integration is unknown. Alu RNA promotes retinal pigmented epithelium (RPE) death in geographic atrophy, an untreatable type of age-related macular degeneration. We report that Alu RNA-induced RPE degeneration is mediated via cytoplasmic L1–reverse-transcribed Alu cDNA independently of retrotransposition. Alu RNA did not induce cDNA production or RPE degeneration in L1-inhibited animals or human cells. Alu reverse transcription can be initiated in the cytoplasm via self-priming of Alu RNA. In four health insurance databases, use of nucleoside RT inhibitors was associated with reduced risk of developing atrophic macular degeneration (pooled adjusted hazard ratio, 0.616; 95% confidence interval, 0.493–0.770), thus identifying inhibitors of this Alu replication cycle shunt as potential therapies for a major cause of blindness.

Significance Alu elements, comprising more than 10% of the human genome, propagate via retrotransposition. This genomic expansion requires enzymatic activity of L1 that reverse transcribes Alu RNA into Alu cDNA in the nucleus. We report Alu also undergoes L1-mediated reverse transcription via self-priming in the cytoplasm independent of retrotransposition, providing evidence of human DNA synthesis in this cellular compartment. This newly discovered shunt molecule in the Alu replication cycle also induces death of the retinal pigmented epithelium, a hallmark of atrophic age-related macular degeneration. A Big Data Archeology analysis of multiple health insurance databases reveals that use of FDA-approved nucleoside reverse transcriptase inhibitors is associated with protection against macular degeneration, identifying a repurposing candidate for this blinding disease.

Perturbative considerations account for the properties of conventional metals, including the range of temperatures where the transport scattering rate is $1/\tau_\text{tr} = 2\pi \lambda T$, where $\lambda$ is a dimensionless strength of the electron-phonon coupling. The fact that measured values satisfy $\lambda \lesssim 1$ has been noted in the context of a possible "Planckian" bound on transport. However, since the electron-phonon scattering is quasi-elastic in this regime, no such Planckian considerations can be relevant. We present and analyze Monte Carlo results on the Holstein model which show that a different sort of bound is at play: a "stability" bound on $\lambda$ consistent with metallic transport. We conjecture that a qualitatively similar bound on the strength of residual interactions, which is often stronger than Planckian, may apply to metals more generally., Comment: 6 pages, 3 figures (+Appendices: 6 pages, 5 figures). Final version published in Proceedings of the National Academy of Sciences

Lithium-sulfur batteries are among the rising rechargeable batteries due to their high energy density, theoretical capacity, and low cost. However, their large-scale application is delayed by several challenges, such as degradation due to polysulfide dissolution, low conductivity, and other restricting factors. Li-S batteries have undergone decades of development aimed at improving battery performance by altering the electrode material to overcome these challenges. In the meantime, due to the depletion of fossil fuels and growing energy demand, the need for changes in processes to improve battery performance is now more urgent than ever. Carbon-based materials like conducting polymers, carbon nanotubes, Graphene, and activated Carbon have gained extensive attention due to their low cost, easy availability, good cycling stability, and exceptional electrical, thermal, and mechanical properties. Here, we summarize recent progress in carbon-based electrode material in Li-S batteries, the development of electrolytes, and progress in adopting lithium-sulfur batteries as flexible devices. Furthermore, a comparison of Li-S batteries based on similar parameters with its rechargeable battery competitors is discussed and a comparison with other non-carbon-based electrodes used in the lithium-sulfur battery is also examined. Finally, a general conclusion and future directions are given.

BACKGROUND: Total knee replacement surgery is among the most common major orthopedic surgery performed in cases of osteoarthritis on the knee joint. Total knee arthroplasty is considered to cause moderate-to-severe postoperative pain. No clear consensus in the available literature suggests a clear advantage between epidural tramadol and intravenous tramadol postoperatively due to the complications associated with an epidural catheter. AIM: This study aimed to determine the effectiveness of epidural tramadol and intravenous tramadol in pain relief and functional recovery in postoperative total knee replacement patients. MATERIALS AND METHODS: All cases operated for total knee replacement and postoperatively managed by epidural tramadol and intravenous tramadol were studied. This group included 20 patients of total knee replacement managed by epidural tramadol compared to 20 patients of total knee replacement managed by intravenous tramadol. RESULTS: Patients in the group managed postoperatively with intravenous tramadol for postoperative pain management showed a better functional outcome and pain relief as compared to patients managed with epidural tramadol. It was noted that in patients managed with intravenous tramadol, the knee range of motion and static and dynamic quadriceps exercises were started earlier and the patients were more compliant, which intern helped to achieve a better functional outcome posttotal knee replacement surgery. CONCLUSION: We would like to suggest in our limited 40 patient study group, the pain managed in patients by intravenous tramadol showed a better functional outcome as compared to the pain managed in the patients by epidural tramadol. Within our study group of 40 patients, it was noted that patient compliance and comfort was better in cases where tramadol was administered through an intravenous line as compared to an epidural catheter with no statistically significant difference in postoperative pain as well as functional outcome and recovery.

Introduction: Among the vasopressor Dopamine and Norepinephrine are most widely used. Till date there is a continuing controversy about whether one agent is superior to the other. Method: This was a prospective randomized trial conducted in a 12 bedded ICU at a tertiary care center from 1st August 2014 to 31stAugust 2015 a total of 1046 patients requiring a vasopressor were randomized, received either Dopamine or Norepinephrine as the first drug of choice to maintain target Mean arterial Pressure.The outcome of the trial at the end was the rate of death at 28 days. Further at the end we would also see the adverse events due to drug and mortality during ICU stay and number of days stay in the ICU and hospital. Result: In the study 521 were assigned to receive Dopamine and 525 were assigned to receive Norepinephrine. The 28 days mortality in Dopamine arm was 51.6% (269/521) and in Norepinephrine arm was 47.2 % (248/525). Arrhythmias was seen more in Dopamine arm (26.12%) compared to Norepinephrine arm (14.40%). Mortality during ICU stay was more in patients who receive Dopamine (51.6%) then to patients who receive Norepinephrin (46.1%) although this difference was not statically significant (P-value >0.05). Further the length of stay in ICU and in hospital was more in patients who received Dopamine (59.20%) than Norepinephrin (57.30%) but it was statically not significant (P-value >0.05). Conclusion: Dopamine when compared with norepinephrine in this study was associated with more arrhythmias and with an increased rate of death in the subgroup of patients with cardiogenic shock. Although the rate of death did not differ significantly between the group of patients treated with dopamine and the group treated with norepinephrine.

We have read the recent report by Mathian et al with great interest where they described the clinical course of COVID-19 in 17 patients with systemic lupus erythematosus (SLE).1 The COVID-19 pandemic has caught the attention of the rheumatology fraternity due to a variety of reasons, such as the in vitro inhibition of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by hydroxychloroquine (HCQ),2 use of tocilizumab in the treatment of cytokine storm3 and concerns regarding cardiac toxicity due to HCQ.4 Patients with SLE are routinely prescribed HCQ and other immunosuppressants. The clinical picture of COVID-19 (such as pneumonia, cardiac injury, renal injury, venous thrombosis and septic shock) in patients with SLE on long-term HCQ described by Mathian et al intrigued the global rheumatology community.1 We assessed the impact of the pandemic on Indian patients with SLE in a larger multicentric survey. We expected that differences in disease expression, ethnicity and treatment may possibly alter the impact of the pandemic in contrast to the aforementioned study. We included patients who had visited their …

Background:A close association between periodontal disease and Ankylosing spondylitis (AS) has long been specualted. Both diseases are characterized by dysregulation of the host inflammatory response, leading to further destruction of soft and hard connective tissue with there being evidence of increased levels of TNF-α and various interleukins in both patients of AS and periodontitis.Objectives:The aim of this systematic review was to appraise the available literature exploring the relationship between AS and periodontal disease.Methods:We searched Medline & Embase databases (from their inception till October 2019) using appropriate combinations of following search items with limits ‘(English, Human)’; Ankylosing spondylitis, spondyloarthritis, spondyloarthropathies, spondyloarthritides, spinal disease, musculoskeletal disease, Rheumatic disease AND periodontitis, periodontal disease, periodontoses, parodontoses, chronic periodontitis, gum disease, gingivitis, oral health, dental health, plaque index, bleeding on probing, probing pocket depth, clinical attachment loss. This search was supplemented by the manual search of bibliographies of articles selected and conferences proceedings of EULAR. Only be reviews, observational study of cross-sectional, cohort or case control type on adult patients with AS were selected. Data was extracted from a predesigned proforma. A close association between periodontal disease and Ankylosing spondylitis (AS) has long been specualted. Both diseases are characterized by dysregulation of the host inflammatory response, leading to further destruction of soft and hard connective tissue with there being evidence of increased levels of TNF-α and various interleukins in both patients of AS and periodontitis.Results:A total number of 984 articles were identified and 12 were selcted for detailed appraisal (Figure 1, PRISMA flow chart). They were all case control studies. The prevalence of periodontitis ranged from 38% to 88% in patients with AS whereas in the control group from 26% to 71 % in controls. Out of 12 studies, two showed significant changes in Plaque Index (PI), two studies showed altered Pocket Probing Depth (PPD), three showed significant increased in Clinical Attachment Loss (CAL) and increased Bleeding On Probing (BOP) was seen in 2 studies. In 7 studies, periodontitis was seen in a significant number of patients with AS (PConclusion:Our systematic review found an association between AS and periodontal disease. Patients with AS show higher prevalence of periodontitis and a poor oral hygiene as compared to healthy controls. At practice level, this systematic review underscores the need for a collaboration between dentists and rheumatologist.Disclosure of Interests:None declared

Background Chikungunya virus is an alphavirus, family Togaviridae. Chikungunya fever is a mosquito born disease transmitted to humans by the bite of infected Aedes aegypti mosquitoes. An outbreak of chikungunya virus is currently ongoing in many Asian countries since January 2005. The recent outbreak and epidemic of Chikungunya fever in our state reflect the survival capability and tenacity of mosquitoes that continues to be man’s biggest foes.An Observational study was conducted to evaluate epidemiological, virological and clinical features of chikungunya fever in patients presenting with acute febrile illness in our state of madhya pradesh. Objectives To observe the clinical features and laboratory parameters of patients coming with Chikungunya coming to our referral setup during the three months of epidemic presenting from 1 st July to 30th September 2017. Methods We included all patients(n=325) presenting to us from age 16 years with acute history( Results We included 325 patients in which Males(M) were 140 and Females(F) were 185, F:M ratio of 1:0.75). The distribution of patients according to age was quite similar across all age groups. Small joints involvement in total of 287 patients (M:40.4%,F:59.6%), axial involvement in 219 patients (M:36.1% and F:67.6%), knee joint involvement in 285 patients (M:41.1% and F:58.9%), ankle pain in 285 patients(M:42.8% and F:57.2%), early morning stiffness was seen in 308 patients (M:44.8% and F:55.19%), eyes involvement in 53 patients (M:35.8% and F:64.2%), Neurological manifestations in 134 patients (M:43.3% and F:56.7%), stomatitis and oral ulcers in 85 patients (M:45.9% and F:54.1%), retrobulbar pain occurred in 73 patients (M:45.2% and F:54.8%), rashes were seen in 47 patients (M:59.6% and F:40.4%). Forty two patients(12.9%) had history of Diabetes(F:73% and M:26%) and 31 patients(9.5%) were hypothyroid with female predominant(100%). Urea and creatinine was also raised(n=18). Rheumatoid factor was positive in 19 patients (M:42.1% and F:57.9%). IgM Chikungunya was positive in 202 patients (M:46.04% and F:53.96%), and out of those 65 patients in which it was negative, we did RT-PCR in 18 patients due to unaffordability being a major factor and we found that RT-PCR came out positive in 15 patients. The mean ESR in males was 41.76±19.98, in females it was 53.66±24.66, mean CRP in males was 29.84±19.61 and in females it was 40.74±25.94. Conclusions We conclude that Chikungunya is a multisystem disease affecting both genders. In our setup, we observed it affected females more and seropositivity for chikungunya was seen in around half of the patients presenting with signs and symptoms. PCR test is more reliable for confirmation. Skin rashes with neurological symptoms, severe pain causing disability and dependence on others for personal care were main complaints. No mortality was reported in our study. Disclosure of Interest None declared

Aim: Understanding the impact of smoking on the development and severity of ankylosing spondylitis (AS) is pivotal, as it affects the management of the disease. This study investigated the effect of smoking in patients with AS and its outcome on the disease. Methods: This was a cross-sectional study from September 1, 2018, to November 30, 2018, in a rheumatology outpatient department enrolled patients aged >18 years diagnosed with AS and divided into two groups according to their smoking status. Demographic details and hematological and biochemical parameters were noted. Modified Schober's test, chest expansion, and duration of disease measurements were performed. Disease activity and functional state were evaluated using the Bath AS Disease Activity Index (BASDAI) and Bath AS Functional Index (BASFI). Results: A total of 48 patients were enrolled (smoker, n = 20; nonsmoker, n = 28). The mean age in smoker and nonsmoker groups was 39.40 years and 26.18 years, respectively, and male preponderance was observed; the mean duration of disease was 42.90 months and 43.14 months, respectively. BASDAI and BASFI scores were significantly higher in the smoker group (5.08 and 4.51, respectively) as compared to nonsmoker group (3.40 and 2.34, respectively) (P < 0.001). The modified Schober's test showed a significant decrease in the range of spinal mobility in the smoker group (2.67 cm) than in the nonsmoker group (4.40 cm) (P < 0.001). A significant decrease in the mean chest expansion was seen in the smoker group than the nonsmoker group (3.08 vs. 5.68 cm; P < 0.001). Conclusion: Results demonstrate the negative effect of smoking on disease and functional activity in patients with AS.

Indoxacarb is a oxadiazine group of insecticide and its toxicity in human is not fully reported. We are reporting a case of 30 years old urban female who presented with a triad of altered consciousness, deep cyanosis and low SpO2 and markedly high PaO2 after ingestion of unknown insecticide with suicidal intent. On strong clinical suspicion of indoxocarb poisoning, we treated her for methaemoglobinaemia with methylene blue and patient recovered fully.

This is with reference to the recently constructed express national highways by the honorable state governments in India, for the sole purpose of speedy connectivity and hustle free transport from one place to another. The aim lies good as far as accidents do not occur. State governments are doing really excellent jobs by connecting major cities and metros across India but side by side creating an open space for accidents to happen and casualties to be added to annual tally of Indian Road traffic accidents list. We have express highways with very good road management. But we are lacking an excellent trauma management centers across express highways within approachable limit and well equipped ambulance system backup with across India toll free number as compared to any of the developed nation basically what constitutes express highways are speedy traffic in terms of two wheelers and four wheelers, absence of proper lightening polls, improper traffic sense and accident caused due to above mentioned factors to a certain extent accidents on national highways/express highways can be prevented as far as Indian scenario is concerned by managing following factors