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Objective Histoplasmosis is an infectious disease caused by the dimorphic fungus Histoplasma capsulatum. Histoplasmosis is considered to be endemic to India, especially the Gangetic belt. Disseminated histoplasmosis may affect almost all systems. Disseminated histoplasmosis with asymptomatic adrenal involvement has been described in immunocompromised patients, whereas isolated adrenal involvement as the presenting manifestation in immunocompetent is uncommon. We aimed to determine the clinicopathological and radiological findings of adrenal histoplasmosis in immunocompetent patients attending a multispecialty diagnostic center referred from different clinics and hospitals. Materials and Methods All tissue samples were initially examined microscopically by performing potassium hydroxide (KOH) wet mounts, followed by culture on two tubes of Sabouraud dextrose agar and phase conversion. Histopathological correlation was done using tissue stains, hematoxylin and eosin, periodic acid–Schiff, and Gomori methenamine silver. Results We evaluated 84 clinically suspected cases radiologically for adrenal mass. The pathological and microbiological work-up was done from these suspected cases. A total of 19 cases were evident from the tissue stain and fungal culture methods. The affected population were mostly above 45 years and male. Seven patients had bilateral adrenal involvement. All these patients received amphotericin B and/or itraconazole treatment, which led to symptomatic improvement in most cases. Conclusion Diagnosis of invasive fungal infection requires a high index of suspicion, especially in immunocompetent patients presenting with nonspecific symptoms, clinical signs, and laboratory and radiological features that often resemble adrenal neoplasms. Clinical specimens, together with fungal culture, must be sent for cytopathology/histopathology for a definite diagnosis and appropriate management.

While the whole world is under attack of a second wave and of a more severe potent mutant form of SARS CoV-2 virus causing SEVERE COVID 19 PNEUMONIA pandemic ,a new disease is on the verge of getting declared as an epidemic named MUCORMYCOSIS OR BLACK FUNGUS (in common term). MUCORMYCOSIS is an umbrella term used for an opportunistic infection caused by several fungi belong to GLOMEROMYCOTAFAMILY(mucor, zygomucor,lichtheimia,syncephalastrumetc) these saprophytic fungi can be found in soil,food damped walled in the environment which were actually considered as an non pathogenic organism to human. In current days it has become an emerging disease in the world especially in india. Now the COVID ASSOCIATED MUCORMYCOSIS has raised a severe threat and fear in india during these second wave of CORONAVIRUS INFECTION.Due to irrational use of the drug PREDNISOLON OR DEXAMETHSONE(which basically belong to steroid group of drugs) for the management of COVID 19 AQUIRED PNEUMONIAMOR,ESPECIALLY FOR THOSE WHO ARE ON HIGH O2 REQUIREMENT has raise 2 issuesone is improper glycemic control,second is severe immunosupressant stage HERE IS A CASE REPORT THAT CAN PROVE THAT CASES OF MUCORMYCOSIS WERE INEVIDENTLY PRESENT IN INDIA EVEN BEFORE THIS PANDEMIC STARTED. A 40 years old male,a cotton mill worker ,was admitted in the emergency observation ward OF IPGME&R AND SSKM HOSPITAL,KOLKATA AROUND THE MONTH OF OCTOBER IN 2018 with random blood glucose level(RBS) 702 gm/dl along with a history of necrotic oral ulcer over the hard pallete extending posteriorly along with left sided nasal blockage with complaint of difficulty to eat and swallow both liquid and solid and rhinolalia since 45 days. There was no history of fever,cough,haemoptysis,no history of trauma to the affected site or tuberculosis. At this point with a high RBS and elevated urea creatinin level patient was diagnosed to be in diabetic ketoacidosis and he was managed with iv. Insuline and hence forth his blood glucose level was kept under control with insulin therapy. While taking the history it came into our notice that the patient is a known case of type 2 diabetes mellitus and CKD-STAGE V due to IgA Nephropathy for which he was receiving Prednisolon which he suddenly discontinued 15 days before admission and he also underwent haemodialysis twice. On local examination he had a necrotic ulcer over the hard palate and necrotic debris in the nasal cavity(as evident in the nasal endoscopy).CT —nose+PNS showed left sided maxi antrum opacity suggestive of pansinusitis . All broad spectrum antibiotics along with iv voriconazol was started as the patient was immune compromised. After 2 days of his admission though his diabetes was under control patient suddenly showed orbital involvement and visual impairement on the left eye.A repeat CT showed progression of the sinusoidal opacity toward the retro orbital space and a bulky oedematous left inferior rectus due to inflammation and then he was refered to microbiology department with a suspection of mucormicosis?.scrapping material was collected from the oral ulceration site and KOH mount was done ? broad aseptate hyphae with acute angle branching? Suggestive of mucormicosis and culture was done in SDA and SDCA media. Culture growth revealed abundant, erected mycelium(around 0.5cm tall) .the surface colour of the colony was at first white to yellow,after a few days the centre tured black?.Lactophenol cotton blue(LPCB) stain from the growth showed wide ribbon like aseptate hyphae with sporangiophores terminated in swollen vesicles with radial merosporangiae with spores A confirmed diagnosis of Rhino orbital zygomycosis due to Syncephalastrum racemosum was made. The patient was put on intensive short acting insulin to achieve optimum glycemic control.As there was high risk of vascular invasion of mucormicosis(which is the most common mode of pathogenecity of these group of fungi) leading to sudden stroke following ischemia a surgical debridement was done and infected tissue was removed. He was put on intravenous liposomal Amphotricine B 300mg daily OD and later shifted to take voriconazole 200 BD.the patient got discharged in favourable condition. Now literature shows Fluconazole, voriconazole, and itraconazole do not have reliable activity against mucormycosis.DRUGS OF CHOICE should be Liposomal amphotericin, Amphotericin B lipid complex, Posaconazole, Echinocandins, Deferasirox. In recent senario during the pandemic many COVID 19 positive patients are getting advices from tele medicine or vedio consultation or many patients are self medicating themseleves learning from various social media in india.Now the taking drugs like prednisolon with out proper monitoring and sudden discontinuation the drug once the patient is feeling better is giving rise to stage of absolute lack of circulating neutrophils causing either pulmonary ,or rhinocerebral or rhino orbital mucormycosis in those patients even after recovering from COVID 19 INFECTION.The HRCT CHEST of those patients with pulmonary mucormycosis is very difficult to differentiate from the ground glass opacity formed in the lungs caused by COVID 19 PNEUMONIA So unsupervised intake of steroids or prolonged use of steroids along with improper use of antifungals are causing the rise of the this opportunistic infection in india which is increasing rate of fatality.

While the whole world is under attack of a second wave and of a more severe potent mutant form of SARS CoV-2 virus causing SEVERE COVID 19 PNEUMONIA pandemic ,a new disease is on the verge of getting declared as an epidemic named MUCORMYCOSIS OR BLACK FUNGUS (in common term). MUCORMYCOSIS is an umbrella term used for an opportunistic infection caused by several fungi belong to GLOMEROMYCOTAFAMILY(mucor, zygomucor,lichtheimia,syncephalastrumetc) these saprophytic fungi can be found in soil,food damped walled in the environment which were actually considered as an non pathogenic organism to human. In current days it has become an emerging disease in the world especially in india. Now the COVID ASSOCIATED MUCORMYCOSIS has raised a severe threat and fear in india during these second wave of CORONAVIRUS INFECTION.Due to irrational use of the drug PREDNISOLON OR DEXAMETHSONE(which basically belong to steroid group of drugs) for the management of COVID 19 AQUIRED PNEUMONIAMOR,ESPECIALLY FOR THOSE WHO ARE ON HIGH O2 REQUIREMENT has raise 2 issuesone is improper glycemic control,second is severe immunosupressant stage HERE IS A CASE REPORT THAT CAN PROVE THAT CASES OF MUCORMYCOSIS WERE INEVIDENTLY PRESENT IN INDIA EVEN BEFORE THIS PANDEMIC STARTED. A 40 years old male,a cotton mill worker ,was admitted in the emergency observation ward OF IPGME&R AND SSKM HOSPITAL,KOLKATA AROUND THE MONTH OF OCTOBER IN 2018 with random blood glucose level(RBS) 702 gm/dl along with a history of necrotic oral ulcer over the hard pallete extending posteriorly along with left sided nasal blockage with complaint of difficulty to eat and swallow both liquid and solid and rhinolalia since 45 days. There was no history of fever,cough,haemoptysis,no history of trauma to the affected site or tuberculosis. At this point with a high RBS and elevated urea creatinin level patient was diagnosed to be in diabetic ketoacidosis and he was managed with iv. Insuline and hence forth his blood glucose level was kept under control with insulin therapy. While taking the history it came into our notice that the patient is a known case of type 2 diabetes mellitus and CKD-STAGE V due to IgA Nephropathy for which he was receiving Prednisolon which he suddenly discontinued 15 days before admission and he also underwent haemodialysis twice. On local examination he had a necrotic ulcer over the hard palate and necrotic debris in the nasal cavity(as evident in the nasal endoscopy).CT —nose+PNS showed left sided maxi antrum opacity suggestive of pansinusitis . All broad spectrum antibiotics along with iv voriconazol was started as the patient was immune compromised. After 2 days of his admission though his diabetes was under control patient suddenly showed orbital involvement and visual impairement on the left eye.A repeat CT showed progression of the sinusoidal opacity toward the retro orbital space and a bulky oedematous left inferior rectus due to inflammation and then he was refered to microbiology department with a suspection of mucormicosis?.scrapping material was collected from the oral ulceration site and KOH mount was done ? broad aseptate hyphae with acute angle branching? Suggestive of mucormicosis and culture was done in SDA and SDCA media. Culture growth revealed abundant, erected mycelium(around 0.5cm tall) .the surface colour of the colony was at first white to yellow,after a few days the centre tured black?.Lactophenol cotton blue(LPCB) stain from the growth showed wide ribbon like aseptate hyphae with sporangiophores terminated in swollen vesicles with radial merosporangiae with spores A confirmed diagnosis of Rhino orbital zygomycosis due to Syncephalastrum racemosum was made. The patient was put on intensive short acting insulin to achieve optimum glycemic control.As there was high risk of vascular invasion of mucormicosis(which is the most common mode of pathogenecity of these group of fungi) leading to sudden stroke following ischemia a surgical debridement was done and infected tissue was removed. He was put on intravenous liposomal Amphotricine B 300mg daily OD and later shifted to take voriconazole 200 BD.the patient got discharged in favourable condition. Now literature shows Fluconazole, voriconazole, and itraconazole do not have reliable activity against mucormycosis.DRUGS OF CHOICE should be Liposomal amphotericin, Amphotericin B lipid complex, Posaconazole, Echinocandins, Deferasirox. In recent senario during the pandemic many COVID 19 positive patients are getting advices from tele medicine or vedio consultation or many patients are self medicating themseleves learning from various social media in india.Now the taking drugs like prednisolon with out proper monitoring and sudden discontinuation the drug once the patient is feeling better is giving rise to stage of absolute lack of circulating neutrophils causing either pulmonary ,or rhinocerebral or rhino orbital mucormycosis in those patients even after recovering from COVID 19 INFECTION.The HRCT CHEST of those patients with pulmonary mucormycosis is very difficult to differentiate from the ground glass opacity formed in the lungs caused by COVID 19 PNEUMONIA So unsupervised intake of steroids or prolonged use of steroids along with improper use of antifungals are causing the rise of the this opportunistic infection in india which is increasing rate of fatality. &nbsp

The Damodar River, a subsystem of the Ganga, has always been flood prone. People as well as governments throughout the centuries have dealt with the caprices of this vital water resource, using structures such as embankments, weirs, barrages and dams. Post-independence the Damodar Valley Corporation (DVC) constructed four multipurpose dams to facilitate regional development and reduce flood hazards. Post-dam hydrographs show decreased monsoon discharges, reduced peak flow and a shifting of peak flow from July to August to September. Despite the DVC dams, the lower valley is still vulnerable to flooding, because the transport capacity of the river has also been reduced. As a result, the frequency of bank full events today is again similar to that observed in the pre-dam period. Because of the control structures once mobile channel char lands have been stabilised and permanently settled by Bangladeshi refugees. These new riparian communities are threatened by the fluvial environment. Changing patterns in riparian land use, fostered by alterations in flow regime, coupled with the long-term prospect of increased rain variability due to climate change, appear to be increasing the risk of rare but devastating floods in the Lower Damodar.

Neonatal septicaemia is an important cause of neonatal morbidity and mortality. Blood culture is the gold standard for diagnosis of neonatal septicaemia. Several laboratory investigations are available to detect neonatal sepsis, one important is 'sepsis screen' which includes C-reactive protein (CRP), micro -ESR, total WBC count including immature to mature (VT) ratio and absolute neutrophil count. Blood culture was done among 210 samples from neonatal intensive care unit (NICU), RG Kar Medical College with suspected septicaemia along with CRP estimation. Among all the parameters, clinical correlation of CRP is significant; 65.2% of patients has blood culture positive. CRP positivity varied in different organisms. CRP is a non-specific acute phase reactant and rises significantly after 12 hours onwards. It can be used as an important parameter in infant at risk of septicaemia (significant6 mg/dl) and early institution of antimicrobials therapy. It has got prognostic value.

Klebsiella especially Klebsiella pneumoniae is gaining renewed interest because of emergence of multidrug resistance among klebsiellae associated with infections.These are now being recognised as one of the major threats to effective management of patients in hospital, especially in developing country like India. Pathogenic mechanism of klebsiella Infections are associated with virulence factors such as capsule and mucoid phenotype, etc. The present study was designed to determine the virulence factors and antibiogram of klebsiellae, isolated from various clinical specimen in a tertiary care hospital of West Bengal, India. A total of 2370 clinical specimens which include blood, urine, wound swab, sputum were processed for isolation and identification of klebsiella to the species level. For each klebsiella isolate demonstration of capsule was done by capsule relief stain and detection of mucoid phenotype was done by string test. Antibiogram was studied by Kirby-Bauer disc diffusion method according to Clinical and Laboratory Standard Institute (CLSI) guidelines. The results showed that klebsiella species were isolated and identified from 139 clinical samples (5.9% prevalence rate) among which 4 (2.9%) were Klebsiella oxytoca and the remaining 135 Isolates (97.1%) were Klebsiella pneumoniae. Out of 139 klebsiella isolates, capsule was demonstrated in 118 (84.9%) and 116 (83.4%) were positive for string test. Antibiogram revealed that most of isolates of Klebsiella pneumoniae were multidrug resistant.

The Lower Damodar should be culturally defined. Forms, processes and materials in the controlled section are generically quasi-natural in character. Social space of Bengali refugees has played a significant role in riverbed colonization and in subsequent land use practices. There is a strong linkage between changing geomorphic space and perceived environment. Land ownership rights are crucial factors in riverbed land utilization. The modified concept of human ecology helps in explaining land uses. There can be no a priori model for human-environment interactions. Human interaction with the environment depends on personal experience. The controlled Lower Damodar is a product of twin processes; quasi-natural hydro-geomorphic processes on the one hand and anthropogenic land-utilization processes on the other.

The Damodar riverbed has been colonized in different phases since 1947, mostly by Bangladeshi refugees. They are self-alienated refugees who have rejected the dole-sustained existence in government-sponsored refugee camps and opted, instead, for life on the controlled riverbed. After India achieved independence in 1947, fuller utilization of the river resources was needed to solve socio-economic problems. At the same time, the partition of India initiated large scale migration, particularly of Hindus from both West and East Pakistan (Present Bangladesh). Of all the refugee-receiving states in India, West Bengal had the maximum number of refugees, a problem that was aggravated after the Bangladesh War of 1970 when there was a fresh influx of refugees from independent Bangladesh. In both phases, a significant number of Bangladeshi refugees selected the riverbeds of West Bengal as their second home. The Lower Damodar bed is one such riverbed. It has been permanently occupied by these Bangladeshi refugees and has become a major resource base for them. The flood of September 1978 also initiated a desperate migration of locals from the flood-affected areas of Medinipur and Hooghly districts to the adjacent riverine sandbars. Control structures on the river have brought many changes to the riverbed environment and the refugees are constantly struggling with this changed environment for their survival.

The Damodar riverbed has provided a home for marginalized communities, but the riverine environment itself has deteriorated; presenting us with a challenge to develop a more holistic and sustainable water management system. There should be a mix of structural and non-structural measures that acknowledge and incorporate local cultural attitudes, experience and knowledge. For effective water resource management, river communities must be part of the effort so their interests are aligned with the aims of the project and they feel committed to the success of the endeavor. River regimes should be treated as economic assets since ongoing economic and human development depend on an ecologically sound riverine environment.

Rivers respond to anthropogenic activities through morphological and hydrological adjustments in the channel. This chapter addresses the hydromorphological consequences of the control structures on the Damodar River. Dams have altered the flow regime, channel characteristics and the sediment supply of the river. Under natural flow conditions, on an average, 12 days per year experienced a flow above 2,265.6 m3/s. This has decreased to 4 days under artificial conditions. Monsoon streamflow has been reduced, but non-monsoon flow has increased albeit with a very high variability in the post-dam period. The R.I. of the bankfull stage, a flow of 7,080 m3/s in the pre-dam period, increased from 2 to 14 years in the post-dam period. The magnitude of the design flood from Maithon and Panchet reservoirs has been reduced by about 56%. During the non-monsoon period canal discharge in most cases exceeds the river discharge. The low volume of water released downstream during dry months virtually transforms this section into a sandy waste whereas the high discharge released during monsoon months converts the section to a vigorous flowing channel. Although some sediment is trapped in the reservoirs, a million tons of sediment nevertheless pours into the river from the uncontrolled stretch. Capacity of the river to transport this sediment has been reduced due to the reduction of flood peaks. A chain of sandbars has emerged within the riverbed below the control structures. The channel deposits in the study area support agriculture and most of the channel bars have been settled and are now used as a resource base, mostly by Bangladeshi refugees.

The Damodar riverbed consists of a series of alluvial bars that are now used as a resource base mostly by refugees. The stretch between Panchet Maithon reservoirs and Barsul-Chanchai is not atypical in terms of contemporary riverbed morphology and bed materials particularly below the Durgapur barrage. But the riverbed landscape, formed by interactions between the riverbed and its occupiers, shows diversity at a micro level. Using their knowledge of river stages, settlers have matched land use at fine scales to flood incidence, applying a concept of flood zoning to the riverbed and effectively utilizing every available inch of space. Functional relations between the riverine environment and riparian community have been influenced by culture, social space, perceived environment, land ownership rights and political forces. As there is no a priori model for human-environment relations, assessment of short-term risks and long-term benefits of water release from the reservoirs and decisions on specific land use are made on the basis of personal experience. The stretch between Maithon/Panchet reservoirs and Barsul Chanchai has become less hazardous and more resource-rich with the mitigation of the annual flood discharge. Here risk is capitalized as resource and long term benefits have overshadowed the short term risk. Paikpara is an example of changing location of the resource base subsequent to a geomorphic threshold. The opening of the Muchi-Begua Hana has transformed an over-bank settlement to a mid-channel settlement. The thalweg of the Amta Channel is extremely narrow compared to the culturally defined riverbed and is not so significant in comparison to the other two sectors of the Lower Damodar.

Floods, once the basis for hydraulic civilizations, are now seen mostly as sources of hazard due to negative interaction between human systems and environmental conditions at particular historical junctures within specific economic and social conditions. The same phenomenon acquires a different dimension if seen rationally as an event with both possibilities as well as perils that one can plan for and guard against. In this study on the Damodar River, physical and human environmental research has been integrated, focusing on river morphology and ecology, human use of river and sandbars or char lands as a resource, and policies that shape a river. This leads us to a more holistic understanding of how the forms and ecological status of a river are shaped by the interplay of environmental and anthropological processes. In other words, this research reviews the impacts of control structures in the downstream environment and also provides a detailed study of human role in changing fluvial regime through descriptions of the way in which people, ranging from refugees to local settlers, driven by diverse cultural, economic, religious, and political forces, have transformed the fluvial landscape.

The Damodar River, a subsystem of the mighty Ganga system, has always been notorious as a calamitous river like the Hwang Ho of China and the Kosi of India. People as well as governments throughout the centuries have dealt with the caprices of these vital water resources using different strategies. In the case of the Damodar, heavy embankments were used in its lower sector to reduce flood hazard in the Rarh plain. When the Damodar Valley Corporation (DVC) was first conceived and modeled after the Tennessee Valley Authority (TVA) of USA in 1948, the river was again controlled, this time through the construction of sophisticated engineering structures. This chapter focuses on the hydrogeomorphic consequences of lateral control structures. The riverbed has been raised, soil composition in the adjacent riparian tract has been changed, cross sections have been increased, and a number of spill channels have been opened on the right bank. In addition, shifting of banklines and bank erosion are observed on the left bank.

Perianal tuberculosis is an extremely rare form of tubercular disease. We report here a case of chronic non-healing perianal tubercular ulcer associated with, asymptomatic pulmonary tuberculosis in a 16-year-old boy for its rarity and to emphasize the importance of considering tubercular etiology in the work up of persistent perianal ulcer.