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Airborne pathogens like Aspergillus bring the lungs in the frontline for defense. Pulmonary diseases caused by Aspergillus species are broadly classified as aspergilloma, chronic necrotizing pulmonary aspergillosis, invasive pulmonary aspergillosis (IPA), and bronchopulmonary aspergillosis. Intensive care unit (ICU) admission is required for a large number of patients associated with IPA. It is not yet known whether patients with coronavirus disease 2019 (COVID-19) are at a similar risk for IPA as for influenza. However, usage of steroids plays a leading role in COVID-19. The family Mucoraceae includes filamentous fungi of the order Mucorales, causing a rare opportunistic fungal infection known as mucormycosis. The most commonly reported clinical presentations of mucormycosis are rhinocerebral, pulmonary, cutaneous, gastrointestinal, disseminated, and others. Here, we report a case series of invasive pulmonary infection by various fungi like Aspergillus niger, Aspergillus fumigatus, Rhizopus oryzae , and Mucor species. Specific diagnosis was made based on microscopy, histology, culture, lactophenol cotton blue (LPCB) mount, and chest radiography and computed tomography (CT). To conclude, opportunistic fungal infections like those due to Aspergillus species and mucormycosis are most commonly associated with hematological malignancies, neutropenia, transplant patients, and diabetes. Therefore, early diagnosis by direct microscopy, surgical interventions, and effective antifungal treatment form the ideal management for invasive fungal infections like aspergillosis and mucormycosis, instead of waiting for the culture reports., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Context: Data collection and statistical analysis are integral components of research. The beauty of statistics lies in its ability to evaluate evidence in the face of uncertainty. However, lack of dedicated biostatistical consultation units, rote academic teaching and training lead to poor statistical analysis. Thus, we aim to explore and understand the challenges of establishing a Biostatistics Clinic (BC) in a tertiary care research institute. A secondary aim is to identify the stage of research at which participants approach biostatisticians., Material and Methods: The data for the current study came from a consultancy unit named as "Biostatistics Clinic" in the department of biostatistics from Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. The residents and students who approached the department of biostatistics for consultancy regarding study design, sample size, statistical analysis and other analytical work were the sampling units., Results: A total of 208 residents and students made 404 visits to biostatistics clinic. The male and female visits were 118 (56.7%) and 90 (43.5%), respectively. Majority of visitors approached for data analysis (171; 75%) followed by study design and sample size calculation for protocol preparation (43; 18.9%). Leading reference to approach the biostatistics clinic was through a faculty (91; 43.8%) followed by self (54; 26%)., Conclusion: Despite the thrust and apparent advantages of contacting statistician at the beginning of the study, majority approached only at the data analysis stage. Therefore, repeated and improved efforts are required to spread the message of approaching statistician early., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Family Medicine and Primary Care.)

Context: The design of the class V cavity presents a clinical challenge in the field of adhesive dentistry as the margin placement is partially in enamel and partly in dentin, and the trouble associated with this design is the microleakage at the dentinal margin. When these restorations undergo microabrasion due to cosmetic reasons, this trouble aggravates to the significant levels., Aims: The aim of this study was the measurement of microleakage of class V glass ionomer restorations over two different periods of enamel microabrasion., Settings and Design: This in vitro experimental study was conducted on 120 class V cavities which had been prepared on the buccal and lingual surfaces of 60 sound human premolars. One-half of the cavities were restored with the resin-modified glass ionomer cement (GIC) (60 cavities) and another half with the compomer (60 cavities). Finishing and polishing were performed., Subjects and Methods: Then, the teeth were classified into six groups (n = 20). Microabrasion treatment was performed with Opaluster (Ultradent Product Inc., South Jordan, UT, USA) for 0 (control no treatment), 60 and 120 s. Then, teeth were thermocycled between 5°C and 55°C, immersed in rhodamine B solution (24 h), and sectioned longitudinally in buccolingual direction. Dye penetration was examined with stereomicroscope (×10). Microleakage scores were statistically analyzed. The mean occlusal margin scores and gingival margin scores were compared between all the groups using the Kruskal-Wallis test, Mann-Whitney U-test, Wilcoxon signed-rank test, and post hoc comparison. There was a significant difference between Group 1a, Group 2a, Group 1b, Group 2b, Group 1c, and Group 2c., Statistical Analysis Used: Statistical analysis used in this study was Kruskal-Wallis test, Mann-Whitney U-test, Wilcoxon signed-rank test, and post hoc comparison., Results: The least microleakage scores were observed in occlusal margins of control groups (without microabrasion). Moreover, in both restorations, the microleakage scores in occlusal margins were higher than gingival margins, and compoglass had less microleakage in occlusal and occlusal plus axial walls of class V cavities compared with resin-modified GIC. Whereas, the light-cured glass ionomer had less microleakage in the gingival and gingival plus axial walls of class V cavities when compared with compoglass., Conclusions: The least microleakage scores were observed in occlusal margins of control groups (without microabrasion). Moreover, in both restorations, the microleakage scores in occlusal margins were higher than gingival margins.

Culture-negative bacteraemia has been an enigmatic entity with respect to its aetiological agents. In an attempt to actively identify those positive blood cultures that escape isolation and detection on routine workflow, an additional step of MALDI-TOF MS (matrix-assisted laser desorption ionization-time of flight mass spectrometry) based detection was carried out directly from the flagged blood culture bottles. Blood samples from 200 blood culture bottles that beeped positive with automated (BACTEC) system and showed no growth of organism on routine culture media, were subjected to analysis by MALDI-TOF MS. Forty seven of the 200 (23.5%) bacterial aetiology could be established by bottle-based method. Based on these results, growth on culture medium could be achieved for the isolates by providing special growth conditions to the fastidious organisms. Direct identification by MALDI-TOF MS from BACTEC-positive bottles provided an opportunity to isolate those fastidious organisms that failed to grow on routine culture medium by providing them with necessary alterations in growth environment., Competing Interests: None

Introduction: Areflexia is one of the cardinal clinical features for the diagnosis of Guillain Barré syndrome. However, some patients may have sluggish proximal muscle stretch reflexes. Presence of thumb reflex, a distal stretch muscle reflex has not been documented in Guillain Barré syndrome., Materials and Methods: We prospectively evaluated thumb reflex in Guillain Barré syndrome patients and age matched controls from April to September 2013., Results: There were 31 patients with Guillain Barré syndrome in whom thumb reflex could be elicited in all (24 brisk, 7 sluggish), whereas all the other muscle stretch reflexes were absent in 29 patients at presentation and the remaining two had sluggish biceps and quadriceps reflexes (P = 0.001). Serial examination revealed gradual diminution of the thumb reflex (P < 0.001). Rapid progression of weakness was associated with early loss of the thumb reflex., Conclusion: Thumb reflex, a distal stretch reflex is preserved in the early phase of Guillain Barré syndrome.

Background & Objective: Resistance to anti-malarial drugs by the parasites is one of the major obstacles to malaria control. The primary objective of this work was to find specific nuclear-encoded-apicoplast-targeted genes that are conserved between two different human malaria parasite species, Plasmodium falciparum and P. vivax to find a common drug/vaccine targets for both the species., Methods: Using computational genomics, possible nuclear-encoded-apicoplast-targeted genes were identified in P. falciparum genome. With comparative genomic approaches, homologous genes were identified between the two different human malaria species, P. falciparum and P. vivax., Results: Of the total 545 reported nuclear-encoded-apicoplast-targeted genes in P. falciparum, we could narrow down to as less as five genes that were found to have highly conserved nucleotide stretches in P. vivax. However, two such genes were of importance, as the majority of the protein coding regions (exons) of these genes were found to be highly conserved between them., Interpretation & Conclusion: This preliminary study shows that nuclear-encoded-apicoplast-targeted genes were conserved between the two human malaria parasites and these could be targeted for developing a common drug to cure both forms of malaria.

Fibrous dysplasia is a non- neoplastic hamartomatous developmental fibro osseous lesion of bone. This paper provides a brief overview of fibrous dysplasia in a historic perspective and highlights the controversies in fibrous dysplasia seen in the cranio- maxillofacial lesions. A case report of a young woman is presented who was diagnosed as having maxillofacial fibrous dysplasia, thereby making an attempt to use this term in cases with relatively limited facial bone disease.

Prognostic significance of non-caseating epithelioid granulomas in association with Hodgkin's disease has been studied. Such granulomas were found in 15 of the total of 104 cases of Hodgkin's disease encountered between Jan. 1981 and June 1990. These 15 patients were compared with 30 concurrent patients of Hodgkin's disease who did not have associated granulomas. All the patients were initially staged, treated and followed up for a period of two years. There was no significant difference in overall survival rate between the granuloma group and the control group. However, in relapse free survival rate in advanced stages of the disease (III & IV), although the difference between granuloma group and the control group was not statistically significant (p = 0.11), yet the relapse free survival curves revealed a tendency towards better survival with lesser number of relapses and longer remissions in granuloma group.

One hundred and four cases of Hodgkin's disease diagnosed between July 1981 and June 1991 have been analysed. There was a definite male preponderance. Majority of the patients (82.7%) were below the age of 50 years. Mixed cellularity was the most common type (57.7%). It was followed by both nodular sclerosis and lymphocyte predominant types (16.3% each). Lymphocyte depletion Hodgkin's disease, the most aggressive variant, was the least common (9.7%). The detailed observations, as compared to the previous studies in this region as well as in other parts of the world have been presented and discussed.

Serum levels of adenosine deaminase (ADA), 5-nucleotidase (5'-NT) and alkaline phosphatase (ALP) were studied in 25 patients of carcinoma breast and 25 normal subjects. Adenosine deaminase was found to be the better probable parameter for the detection of cancer and to assess the development of various stages of cancer whereas 5'-nucleotidase had only diagnostic significance. Serum alkaline phosphatase levels were important for assessing the spread of cancer at secondary sites. After mastectomy a significant decrease was found in the levels of serum ADA and 5'-NT whereas no variations were found in case of serum ALP.