Raval, Darshankumar Manubhai

Abstract Background The COVID-19 pandemic saw a worrisome rise in mucormycosis cases in India, especially among those receiving corticosteroid therapy. While corticosteroids are essential for managing severe COVID-19 cases, their immunosuppressive action appears to augment infection risk. Clinically, prolonged steroid use may result in severe forms of mucormycosis; however, this requires rigorous systematic evaluation. Methods We conducted an exhaustive analysis of 327 mucormycosis cases and 596 COVID-19 controls, all of whom were treated during the second wave in India. Exposure to steroids was carefully categorized by duration into three groups: short-term (1-5 days), standard-term (5-10 days), and long-term ( > 10 days). Each case was biopsy-proven, with further radiographic confirmation of disease extent. Special emphasis was laid on intracranial extension as a marker of severity, along with tracking treatment outcomes and survival. Statistical modeling was used to correct for important confounders, including diabetes status, glycemic control, and concurrent use of other immunomodulators. Results The results were striking. Those receiving steroid treatment for more than ten days of duration had a nearly fourfold higher incidence of intracranial mucormycosis compared with short-term-treated patients (38.2% vs. 12.5%, p< 0.001). Each day of steroid use accounted for a 12% increase in associated risk. While mortality rates were equal, patients receiving prolonged treatment had a considerably increased number of surgical procedures (35.3% vs. 16.7%, p=0.02) as well as more complicated hospitalization. Those with diabetes were especially sensitive to such effects of prolonged treatment. Conclusion The study highlights the role of cautious use of corticosteroids in the management of COVID-19. Our work gives strong evidence for the importance of compliance with guideline-based recommendations for corticosteroid duration, especially for high-risk populations. This study empowers healthcare practitioners with unequivocal evidence to provide optimal COVID-19 treatments while avoiding the risk of severe fungal infection. Disclosures All Authors: No reported disclosures

Abstract Osteomyelitis pubis, a rare form of osteomyelitis affecting the pubic bone and symphysis, is an often-misdiagnosed condition accounting for less than 1% of all osteomyelitis cases. We present the case of a 41-year-old-male diabetic patient on sodium-glucose-co-transporter-2 (SGLT2) inhibitors, specifically dapagliflozin, who developed osteomyelitis pubis and associated septic arthritis and pyomyositis. Despite a well-controlled diabetes profile and the absence of typical risk factors, the patient's condition progressed rapidly leading to severe pain and functional impairment. Imaging studies revealed extensive infection, and culture results identified Pseudomonas aeruginosa , necessitating a complex, multistage antibiotic regimen. The patient responded positively to treatment but experienced complications, including drug-induced agranulocytosis. This case underscores the potential link between SGLT2 inhibitors and osteomyelitis, highlighting the need for increased clinical vigilance and the careful assessment of risks when prescribing these medications to diabetic patients. Further research is warranted to better understand the association between SGLT2 inhibitors and osteomyelitis pubis.

Objectives Aircrew are subject to thermal stress and heat-related illness (HRI). Published screening methods and safety thresholds remain limited. The objective of this review was to evaluate the available evidence, approaches and guidelines regarding HRI screening tools in aircrew and analogue occupational and athletic cohorts to create a broad compendium of relevant tools for aviation safety decision-makers which establish risk stratification. Design A systematic literature review was conducted through 28 July 2025, of manuscripts and technical documents that reported HRI risk screening approaches. Pairs of independent reviewers selected studies and appraised risk of bias. Data sources Ovid MEDLINE and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Daily, Ovid EMBASE, Ovid Cochrane Central Register of Controlled Trials, Ovid Cochrane Database of Systematic Reviews and Scopus were searched. Eligibility criteria Extrinsic and intrinsic factors checklists, protocols, diagrams, algorithms and screening approaches for HRI risk stratification and safety thresholds within occupational settings were included. Cohorts under 18 years of age and abstracts were excluded. Data extraction and synthesis 3472 reports were identified and 37 were included in the final analysis. Common approaches relied on wet bulb globe temperature (WBGT), workload assessment and personal protective equipment used. WBGT thresholds ranged 27–32°C for extreme risk and 23–31°C for high risk. Identified tools used 19 common domains to establish risk. Data were insufficient to identify a singular ideal screening approach. Conclusions This systematic review addresses knowledge gaps regarding occupational HRI risk screening protocols for use towards aviation workers. Limitations included lack of generalisability, risk definition variability and conflicting published author assumptions regarding intrinsic factors considered.

Introduction: Hyponatremia is a common electrolyte abnormality that has been associated with poor outcomes in several conditions including acute myocardial infarction (AMI). However, those studies were performed in the era before percutaneous coronary intervention (PCI), focused mostly on ST-elevation myocardial infarction (STEMI), and sodium levels up to 72 h of admission. Aim: The purpose of this study was to identify the prognostic importance of hyponatremia in patients with acute myocardial infarction. Methods: We performed a cross sectional and retrospective analysis of 100 patients with a diagnosis of non-ST-elevation myocardial infarction (NSTEMI) and STEMI presenting at PSH, Vadodara, Gujarat, India from January 2022 to May 2024. Our independent variables were sodium levels on the day of admission. Dependent variables were in-hospital mortality, 30-day mortality, length of hospital stay, intensive care admission, new heart failure diagnosis, and ejection fraction. Infarct size was determined by echocardiographic examination that was performed on admission, day 2 or 3 of hospitalization Results: Hyponatremia, defined as a plasma sodium level <135 mmol/L (<135 mEq/L). 32% of patients had hyponatremia up to 7 days of admission. Intensive care admission was higher in patients with hyponatremia up to7 days (70% vs 383%), they had worse 30-day mortality (15% vs to 3%), in hospital mortality (12% vs 2%), and new heart failure diagnosis (32% vs 16%). Hyponatremia on admission was associated with in-hospital mortality (15% vs 4%), 30-day mortality (19% vs 6 %). Conclusions: This study suggests that hyponatremia on admission and at any point during the first seven days of hospitalization are associated with in-hospital and 30-day mortality and prognosis worsens with the severity of hyponatremia. Further studies are required to determine if plasma sodium levels may serve as a simple marker to identify patients at high risk.

Background: Mycobacterium nebraskense is a rare, slow growing nontuberculous mycobacterium species with limited documented cases. This systematic review aims to comprehensively analyze the clinical characteristics, presentation, and management of M. nebraskense infections by analyzing the available literature, including a newly reported case that we present in this article. Methods: A comprehensive search was conducted using PubMed and Google Scholar to identify relevant cases up to October 2023. Only seven reported cases were found, highlighting the scarcity of information on this pathogen. Results: Our analysis revealed several key findings. First, gender disparities were observed, with females being more susceptible to M. nebraskense infections. Additionally, a significant portion of patients presented with asymptomatic infections. Most affected individuals were over the age of 60, emphasizing potential age-related susceptibility. Comorbidity profiles varied widely among cases, and patients with preexisting lung comorbidities were at an increased risk of infection. The decision to treat or observe depended on clinical presentation, with even immunosuppressed individuals not always requiring treatment. Regarding treatment, we proposed an empirical approach with amikacin, clarithromycin, or rifabutin, considering the reported resistance to doxycycline and minocycline. Combination therapy was commonly employed to minimize resistance development, consistent with mycobacterial infection management. Conclusion: This study underscores the need for further research to validate these findings and enhance our understanding of M. nebraskense infections. As limited data are available, this review aims to provide valuable insights into a rare and emerging pathogen to guide clinical practice and future research endeavors.

Chronic myeloid leukemia (CML) is usually a disease of the elderly population characterized by a clonal hematopoietic progenitor cell disorder propelled by the product of the breakpoint cluster region-Abelson murine leukemia (BCR-ABL) chimeric gene, known as the Philadelphia chromosome. It occurs due to a balanced reciprocal translocation between the long arms of chromosomes 9 and 22, which codes for tyrosine kinase. The incidence of CML increases with age, and the median age of diagnosis in Western countries is 64 years. The most common finding at presentation is abdominal pain due to splenomegaly which is present in about half of the patients. We present a rare case of CML in the chronic phase where a young 23-year-old male presented with complaints of severe bilateral lower limb bone pain restricting mobility at the hip joint for 1 year. The upper end of the femur showed heterogeneous areas of bone infarct on the technetium 99 m-methylene diphosphonate bone scan. He was treated with imatinib mesylate, and he entered remission within 5 months of starting therapy. This case highlights the atypical presentation of the chronic phase of CML with the e13a2 BCR-ABL fusion transcript in a young patient and the complete recovery achieved with standard therapy.

Abstract Neuromyelitis optica (NMO), or Devic’s disease, is one of the demyelinating disorders of the central nervous system, with autoimmune inflammatory etiology. The optic nerves and spinal cord are the major organs involved in the disease; however, the involvement of the brain can also be seen in rare instances. Here, we report a case of a 34-year-old female, diagnosed with NMO and concurrent nephrotic syndrome (NS). NMO was diagnosed by positive Aquaporin-4 antibodies in the serum, radio imaging such as magnetic resonance imaging of the brain and spinal cord showing the demyelinating lesions, as well as the presence of optic neuritis on visually evoked potential. Biochemical investigations revealed heavy proteinuria, hypoalbuminemia, and hypertriglyceridemia, meeting the diagnostic criteria of NS. Therefore, considering the diagnosis of NMO with NS, the patient was treated with plasmapheresis and methylprednisolone pulse therapy. This concurrence is very uncommon in clinical practice, as previously only two such cases are reported to date.

Sickle cell disease (SCD) mainly manifests in early childhood. During the first 6 months of life, infants are largely protected by high levels of hemoglobin F; soon thereafter, the disease becomes evident in form of various crises such as vaso-occlusive crisis, hemolytic crisis, and acute chest syndrome, and in rare instances aplastic crisis. Therefore, the majority of patients with SCD are diagnosed in childhood or adulthood, whereas those with sickle cell trait usually remain asymptomatic. However, here, we are presenting a rare case in which a patient has been diagnosed to have SCD for the 1st time at the age of 60 years while being treated for dengue and severe anemia. Our case is one of the rare presentations of SCD, as she never required any blood transfusions even during childbirth and without any sickle crises; therefore, she might not be diagnosed with SCD till her presentation to our hospital. This indicates that advanced age should not be considered as an exclusion criterion for the suspecting and diagnosis of SCD. This case outlines the need for awareness and incorporation of screening for sickle cell anemia in childhood or adulthood as same thalassemia screening programs. The early diagnosis by screening programs will ensure appropriate treatment and therefore improve the quality of life in such patients.