Pseudo Membrane Research Articles

India's Pink-Eye Mystery: Decoding the 2023 Conjunctivitis Outbreak.

The pink eye outbreak in 2023 was caused due to humid weather conditions in most regions of India. The most affected states include Delhi, Gujrat (21% cases), Maharashtra (30%), Himachal Pradesh (4%) and Karnataka (4%). The epidemiological data indicates that males have a high prevalence rate as compared to females; urban areas were most affected, and professionals as well as students were the population group that had the highest prevalence rate. The most common clinical manifestations were the presence of red eye, eye discharge, grittiness, and eyelashes being stuck together. One of the hallmarks of histopathology is a cobblestone formation of flattened nodules with central vascular centers. Conjunctivitis is a virusmediated immune response accompanied by inflammation, which proceeds the immune reaction, giving rise to vasodilation, pseudo membrane formation, and conjunctivital discharge. The gold standard for the diagnosis of Conjunctivitis is the Adenoplus kit using PCR technology; apart from this slit lamp biomicroscope can be used for the evaluation. It is the need of the hour to spread awareness about the Pink Eye disease and the measures to prevent it.

Clinical profile and risk factors for mortality in children admitted with diphtheria: an observational study

Background There is an ongoing resurgence of diphtheria infection worldwide despite a vaccine being available to prevent it for more than four decades. Objectives To study the clinical characteristics and risk factors for mortality of diphtheria cases among children 1–12 years of age treated in our hospital from 1 April 2014 to 31 March 2021. Methodology The data of hospitalised cases of childhood diphtheria from 1 April 2014 to 31 March 2019 were retrospectively analysed from the medical records department of our hospital. All hospitalised children with diphtheria from 1 April 2019 to 31 March 2021, were prospectively studied. All categorical variables were expressed as proportion/percentage and all continuous variables were expressed as median with interquartile range (IQR). Risk factors for morbidity and mortality were analysed and tested for significance. Unadjusted odds ratio (OR) was calculated and significant variables were subjected to multivariate logistic regression. Results Of the 58 children with diphtheria, 62% were lab-confirmed, most cases (45%) were between 5 and 9 years of age. Majority (57%) were completely immunised as per the national immunisation schedule. Fever (97%) was the most predominant clinical symptom. The classical diphtheria pseudo membrane was identified in all. Respiratory failure was the most predominant complication, followed by myocarditis and acute kidney injury. The case fatality rate was 8.6%. Conclusion Diphtheria cases were seen among children 5–9 years of age more commonly. Infection requiring hospitalisation was seen in vaccinated children too. No atypical manifestations were observed. Complications of the disease adversely affected the overall survival.

Primary Laryngeal Aspergillosis in the Immunocompetent Patient

Introduction Fungal infections of the larynx are truly rare in immunocompetent people with only a handful of cases reported in the past five decades. Here we present a case series of 3 people (from 2019 to 2021), with no comorbid conditions, who presented with primary laryngeal aspergillosis. Materials and Methods Three patients with primary aspergillosis of the larynx were seen in the ENT outpatient department from 2019 to 2021, aged between 40-50 years of which two were females and one patient was a male. We describe the clinical presentation of each patient. Discussion Aspergillosis of the larynx usually occurs secondary to bronchopulmonary infections in the immunocompromised. The usual etiological factors include prolonged use of inhaled steroids, cytotoxic drugs, radiotherapy, smoking, mucosal injury, and antibiotic abuse. Persistent hoarseness of voice is the most common presenting symptom. Video laryngoscopy reveals erythema, oedema, hyperkeratosis, adherent white plaques, shallow ulcerations, and grey or white pseudo membrane formation over the vocal cords. Definitive diagnosis is done by the demonstration of hyphae either by KOH staining, culture in Sabouraud Dextrose Agar at 28 degrees Celsius, or tissue biopsy. Conclusion Primary aspergillosis of the larynx has occurred more frequently in recent times. Aspergillosis of the larynx can often mimic malignant or premalignant lesions. Persistent hoarseness of voice not responding to treatment should also raise a suspicion of fungal laryngitis, in the clinician and relatively simple treatment be done before significant morbidity occurs.

S2162 Ulcerative Rectal Mass Complicated by Recto Cutaneous Fistula: Cytomegalovirus as a Culprit

Introduction: Gastrointestinal(GI) involvement with cytomegalovirus(CMV) is uncommon in immunocompetent hosts. The colon is the most commonly involved site followed by the upper GI tract. Rectal involvement is very rare. Case Description/Methods: An 80-year-old male presented to the hospital with a 3-month history of watery diarrhea with occasional blood, fecal incontinence,40-pound weight loss, generalized weakness, anorexia, perirectal pain, and drainage in the perianal area. He was treated with outpatient doxycycline without improvement. He denied fever, nausea, vomiting, and abdominal pain. Past medical history did not point to an immunocompromised condition. On presentation, he was hemodynamically stable. Abdomen was soft, non tender. During the rectal exam, a firm tissue was felt in the distal rectum. There were 3 perirectal fistulas, draining yellowish liquid. CT abdomen and pelvis showed circumferential rectal wall thickening up to 1.8 cm, involving anterior aspect consistent with rectal mass without regional lymphadenopathy or distant metastasis. Sigmoidoscopy revealed an ulcerated rectal mass with an associated fistulous tract, with negative biopsies for malignancy and positive immunohistochemistry(IHC) for CMV. Serological testing for CMV IgG, IgM, and PCR were positive. Workups including ANA, hepatitis panel, HIV RPR, Stool PCR for Clostridium difficile, and TSH were unremarkable. He was treated with Intravenous Ganciclovir. After 2 consecutive PCR negatives for CMV, maintenance therapy with Valganciclovir was started for a total of 5 weeks. He was followed in the outpatient setting. His symptoms were improved. He also had a significant decrease in perianal drainage (Figure). Discussion: Cytomegalovirus is well recognized to cause opportunistic infection in an immunocompromised host. Infection in the immunocompetent host is generally mild or asymptomatic. However, in rare situations, it can lead to severe infection with substantial mortality and morbidity. CMV proctitis commonly presents as hematochezia, and weight loss. Endoscopically it presents as ulcers, pseudo membranes, or a mass. CMV proctitis complicated with a deep rectal ulcer with fistula formation like in our patient is very rare. Ganciclovir is the gold standard therapy. Clinicians should have a high index of suspicion for CMV proctitis irrespective of their immune status in patients with chronic diarrhea, weight loss, and rectal mass. Timely diagnosis and treatment with appropriate antiviral therapy are crucial.Figure 1.: Flexible Sigmoidoscopy showing ulcerated rectal mass with the surrounding area of erythematous, furrowed rectal mucosa.

Severe uremic stomatitis in a patient with untreated chronic renal failure

A 36-year-old female patient with chronic renal failure was referred by the internal medicine department for severe and painful oral lesions extending to the nasal mucosa. The patient´s medical record revealed that she did not receive dialysis during the last 2 months. Oral examination revealed white hyperkeratotic lesions of the tongue together with a diffuse erythema covered with thick whitish-yellow pseudo membrane. An ulcerated, painful lesion of 3 cm in size was present in the hard palate. Similar lesions were present in the nostrils, especially on the right side. Painful plaques and crusts were also present in both lips. The patient reported severe burning sensation, xerostomia, and halitosis. She was also suffering from loss of appetite, nausea, and dysphagia. Severe weight loss was also noted. Laboratory tests revealed elevated serum creatinine: 711umol/l ( normal 40-115umol), uremia: 32.8mmol/l (normal 2.8-7.2mmol/l), and uric acid 889umol/l (normal 180-420 umol). Protein C reactive was also elevated with 42 mg/l normal

Effects of channel geometry and electrode architecture on reactant transportation in membraneless microfluidic fuel cells: A review

The review article introduces the development in membraneless microfluidic fuel cells (MMFCs) focusing on the microchannel geometry and electrode architecture and arrangement. Lamination of fuel and oxidant streams in a microchannel lets an MMFC work without physical membrane. The lack of convective mixing across liquid–liquid interface of two streams forms a distinct diffusive mixing region, which acts as a pseudo membrane. The ions can transport across the channel through the mixing region to reach the other side of the channel and complete the ionic conduction. The advantage of MMFCs lies in the absence of the membrane, as the problems associated with the membrane are eliminated. The channel geometry and electrode architecture have been investigated extensively to eliminate the problems caused by the mixing and depletion regions, which affect the performance significantly, such as power and current densities. The absence of instabilities due to the convective mass transer along the channel allows streams containing different substances with different concentrations to flow side by side axially through a microchannel, whereas the reactant’s mass transfer across the channel in an MMFC is mainly diffusion-limited. This review article mostly focuses on how the channel and electrodes can be designed effectually to enhance the mass transfers by reducing mixing and depletion regions. Additionally, the current status of theoretical and computational modeling for MMFCs to improve the performance are discussed. Moreover, the key issues and main challenges for prospective development of MMFCs are presented.

The Return of the Dragon Faucial Diptheria

Diphtheria is caused by toxin producing strains of gram positve bacilli Corynebacterium diphtheriae. Epidemics occur when immunizaton coverage is inadequate. The characteristc pseudo membrane of diphtheria is formed by necrotc tssue, in?ammatory exudates, fbrin and colonies of the organism and bleeds on removal. Other di?erentals of membranous tonsillits include infectous mononucleosis, streptococcal pharyngits and Vincent’s angina. Diphtheria should be considered in all cases of membranous tonsillits in the appropriate epidemiological background, and anttoxin treatment should be initated promptly

Resurgence of diphtheria and its outcome among children in western Uttar Pradesh: a battle to conquer

Background: Considered as a rare clinical entity in immediate post-vaccination era, diphtheria has now started gaining surface in India for last few years, with an epidemiological shift involving older children owing to poor immunization coverage and waning immunity. Thus, it is imperative to quantify disease burden, analyses the clinical profile and factors affecting the outcome of diphtheria in children.Methods: A prospective observational study conducted in the Pediatric department of a teaching hospital where all children admitted with clinical diagnosis of diphtheria during the study period were included. Demographic data and clinically relevant information along with complications and outcome were recorded. Cases were managed as per standard treatment protocol providing intensive care support wherever required. Complications and factors affecting the outcome in all diphtheria cases were analysed.Results: Total 53 children were enrolled into study, and the mean age of study population was 7.55±2 years. Fever, pseudo membrane and throat pain were observed in all the cases. Palatal palsy was the earliest and the commonest complication (60.4%) followed by myocarditis (55%). Case fatality rate was 33.9% and myocarditis (77%) was the commonest complication attributing to it. Poor immunization status, late presentation and delayed ADS administration were associated with increased complication rate and unfavorable outcome.Conclusions: Robust immunization activity coupled with improved case-based surveillance would go a long way in preventing further diphtheria outbreaks in community. Sensitization about this re-emerging disease and high index of suspicion in diagnosing it, amongst primary care physicians and peripheral health workers would promote early referral and prompt management thereby reducing morbidity and high mortality associated with diphtheria.

Epidemic Keratocunjunctivitis Treatment and Management

Epidemic keratoconjunctivitis (EKC) is a viral conjunctival and corneal inflammation with high contagiosity, which, if is not adequately treated, may cause blurred vision for several years. The purpose of this study was to describe the clinical and epidemiological characteristics of adenoviral keratoconjunctivitis, as well to present the latest news regarding diagnosis, treatment and prophylaxis. Are known two well-defined clinical syndromes of adenoviral keratoconjunctivitis: epidemic keratoconjunctivitis and faringococcal fever, which are caused by various serotypes of adenoviruses. The exact incidence of adenoviral keratoconjunctivitis is not known. However, it mainly occurs during the winter months. Infection can occur during direct contact or through equipment, devices in ophthalmologic ambulances, etc. The virus is extremely resistant to various chemical and physical agents. Symptomatology is similar to other types of conjunctivitis, with high incidence of conjunctival pseudo membrane formation. In the cornea, the changes varying from epithelial punctate keratitis to sub epithelial infiltrates and the creation of nummular keratitis that leads to visual impairment. Diagnosis is mainly clinically decided, and etiology can be confirmed based on cell culture analysis. Conclusion: Until now there is no approved therapy against epidemic adenoviral keratoconjunctivitis. Uncontrolled use of antibiotics, particularly corticosteroids, which reduce tissue resistance, is responsible for the deterioration of such conditions. Priority in prevention EKC is the rigorous application of hygienic disinfectant measures in hospital areas, respectively medical devices in ophthalmologic ambulatory services.

Inorganic Pseudo Ion Exchange Membranes—Concepts and Preliminary Experiments

Reverse electrodialysis (RED) is a method to produce electricity from the reversible mixing of two salt solutions with different concentrations. RED was first employed for energy generation using sea and river water. New fields of application are energy storage and heat-to-power conversion. In energy storage applications, a stack operates in ED mode during charge and in RED mode during discharge. In a heat-to-power system, the RED stack produces electricity and the outgoing solutions are returned to their original concentrations in a heat-driven regenerator. In both new applications, the salt solutions are circulated and there is a free choice of the combination of salt and membranes for optimal performance. However, classical polymer-based membranes have some disadvantages: they are less suited for operation at higher temperatures, have reduced permselectivity at higher concentrations, and are rather permeable to water, causing an imbalance of the feed waters. We developed a new concept of pseudo-membrane (PM): a metal sheet (sometimes covered with an insoluble salt) on which opposite electrochemical reactions occur at each side of the metal surface. Because a PM is dissolving at one side and growing at the other side during operation, the current should be inverted periodically. We tested a zinc sheet as a pseudo cation exchange membrane for Zn2+ ions and a silver chloride–covered silver plate as a pseudo anion exchange membrane for Cl− ions in three steps. First, a stack was built with Ag/AgCl membranes in combination with normal cation exchange membranes and operated with NaCl solutions. The next stack was based on Zn membranes together with normal anion exchange membranes. This stack was fed with ZnCl2 solutions. Finally, we tested a stack with zinc and Ag/AgCl pseudo-membranes with a ZnCl2 solution. The latter RED system worked; however, after standing for one night, the stack did not function and appeared to be damaged by redox reactions. This failure was the basis for general considerations about the possibilities of ED and RED hybrid stacks, consisting of a combination of classical and pseudo ion exchange membranes. Finally, we consider the possibility of using intercalation electrodes as a pseudo-membrane.

A study on clinical and epidemiological profile of patients admitted with white patch in throat to Sir Ronald Ross Institute of Tropical and Communicable Diseases, Hyderabad, India

Background: One of the most common differential diagnosis for a white patch in throat is diphtheria. Diphtheria is an acute infectious disease caused by toxigenic strains of corynebacterium diphtheriae. These bacilli release powerful exotoxin which is responsible for formation of white or greyish or yellowish membrane commonly over tonsils, pharynx or larynx. The objectives of the study were to determine the clinical and epidemiological factors of cases admitted with white patch in throat; to assess the microbiological confirmation rate of diphtheria among cases with white patch in throat; to identify the mortality and morbidity among study population.Methods: A cross sectional record based retrospective study was carried out at Sir Ronald Ross Institute of Tropical & Communicable Diseases, Hyderabad. All the cases admitted in year 2016 with a white/grey/yellowish patch in throat were included in the study. The study was carried out for 2 months.Results: A total of 230 cases were reported and 46.1% of cases were in the age group of 11-20 years. Males constituted about 48.3% and females 51.7% of study population. The most common clinical presentation was Sore throat, fever and a pseudo membrane over tonsils/pharynx. A total of 12 deaths occurred among 230 cases.Conclusions: Deaths occurred most commonly in the younger age group and in the non-immunized. Recovery was faster and the course of illness was uncomplicated in the older age group and in completely immunized individuals.

DETEKSI CLOSTRIDIUM DIFFICILE TOKSIGENIK MENGGUNAKAN UJI CEPAT TOKSIN DAN REAL TIME POLYMERASE CHAIN REACTION (Toxigenic Clostridium Difficile Detection Using Toxin Rapid Test and Real Time Polymerase Chain Reaction)

Toxigenic Clostridium difficile infection, causing a Pseudo Membrane Colitis (PMC) and Clostridium Difficile Associated Diarrhea(CDAD) has increased sharply. The largest risk factor is the use of antibiotics. The purpose of this study was to know how to determinethe prevalence and characteristics of subjects with Toxigenic Clostridium difficile and to assess the ability of the toxin rapid test comparedto real-time PCR. Ninety adult subjects with antibiotic therapy more than two (2) weeks were enrolled in this study. The results of toxinrapid test and real-time PCR were presented in a 2x2 table, statistical test used was Chi square. The prevalence of Toxigenic Clostridiumdifficile based on the toxin rapid test and by real-time PCR was 27.3% and 37.5%, respectively. There were significant differences betweenstool consistency and number of antibiotics used with the detection of Toxigenic Clostridium difficile. There was a relationship betweenthe duration of antibiotic therapy with the detection of Toxigenic Clostridium difficile using real-time PCR (p=0.010, RR=2.116). Thesensitivity, specificity, PPV, NPV, PLR and NLR rapid test against real-time PCR were 69.7%; 98.2%; 95.8%; 84.4%; 39.2 and 0.31,respectively. This study concluded that the prevalence of Clostridium difficile in RSCM was higher compared to that in Malaysia, Thailandand India; the subjects with antibiotic therapy for more than four (4) weeks had a double risk to have Toxigenic Clostridium difficilethan subjects with antibiotic therapy for less than that time (4 weeks). Thus, in this study, toxin rapid test could be used as a tool todetect Toxigenic Clostridium difficile.

Diphtheria Outbreak in Bait Hulboob, Wasman Villages, Ibb governorate - Yemen, September 2017

Background: Remerging of diphtheria outbreaks have been associated with wars and threaten the health of children and adult. On 25th of September 2017 surveillance officer of Ibb governorate received a notification from surveillance coordinator of Alsaddah district about suspected deaths due to diphtheria. A team from Ibb surveillance office was sent to investigate on 26/09/2017. Objective: To verify the existence of an outbreak, describe its epidemiology and recommend preventive and control measures. Methods: A descriptive study was done. WHO case definition was used. A line list was created, active case finding, and clinical diagnosis were performed. Records of surveillance and vaccinations programs were reviewed. Data was entered and analyzed using Excel program. Descriptive statistics were performed. Results: A total of 63 cases were identified. The first case was in Epi week 34, the highest peak with 32 cases were in week 38. The index case was 17 years old male from Bait Hulboob village. The majority of cases 47 (74%), were from that village. Almost three quarters of cases 45 (71%) were males, 22 cases (35%) among children aged from 5-10years. 43 cases (68%) was unvaccinated and the rest was partially vaccinated. All presented with pseudo membrane, 42 cases (67%) with sore throat and 10 (16%) with bull neck. The attack rate was 15/1000. 4 cases died (the case fatality rate was 6%). Conclusions: Diphtheria outbreak was clinically confirmed. Low vaccination coverage. Vaccination campaign for population and provision of Diphtheria antitoxin for patients are urgently recommended. Immunization and health education should be emphasized by governorate authority.

二维周期性单胞网格结构的等效热弹性分析

The thermo-elasticity of 2D lattice structures with periodic unit cells was studied. The lattice structure was homogenized as a pseudo-membrane (PM) structure and the equivalent thermal expansion coefficients (TECs) of the PM were derived. The TECs were expressed as explicit functions of the geometrical and physical parameters of the links in unit cells. Simultaneously, the elastic properties were re-defined based on the new geometry of the unit cell under thermal load. Numerical results were given to show the difference between the deformations of the structure under different thermo-mechanical loads, and a uniform pressure was applied on the top surface of the cantilever beam with or without thermal loads (the temperature increment was positive, negative or null, respectively). In simulation, the deformations of the lattice structure beams (with different sizes of unit cells) and the corresponding PM beams were calculated numerically. The theoretical solution of the beam deformation was also given with the elasticity of the PM beam. Differences between the solutions verify the correctness of the derived equivalent parameters. Results show the validity of the PM method for equivalent thermo-mechanical analysis of 2D lattice structures with periodic unit cells.

Fulminant Clostridium difficile colitis: new challenges in critical care medicine

Fulminant Clostridium difficile colitis (FCDC) means severe Clostridium difficile colitis (CDC), which often manifested with severe diarrhea, fever, abdominal distention, electrolyte disorder, hypoalbuminemia, and it can lead to pseudo membrane colonitis, toxic megacolon, bowel perforation, septic shock, and multiple organ dysfunction. Now Clostridium difficile (CD) becomes one of the most important medical institutions related infectious pathogens. In particular, the recently discovered mutant CD strain NAP1/BI/ribotype 027 has high pathogenicity in the global epidemic and its outbreak. The morbidity and mortality of FCDC has a significant upward trend in the global in recent years. All broad spectrum antimicrobials usage is considered to be the primary risk factor for the onset of FCDC. Therefore, FCDC has become a new challenge for clinical work. The epidemiology, related risk factors, pathogenesis, diagnosis, severity classification, recent progress in clinical treatment of FCDC were reviewed in order to provide help for clinical treatment of FCDC and related research.

The experience of treatment of coblation assisted surgical approach to Eagle’s syndrome

ObjectiveThis article aimed to Summarize our therapeutic experience with Transoral coblation assisted surgical approach used for treatment of Eagle's syndrome. Methodssixty-two consecutive patients, from 2010 to 2015, underwent coblation assisted surgical treatment to remove elongated styloid process transorally. Outcomes were assessed in terms of intraoperative and postoperative complications, patients' evolution and efficiency of treatment. ResultsThe amount of bleeding was 1ml~4ml, average 2.7ml, unilateral operation time was 3min to 10min, average 6.2min, bilateral for 7min to 15min, average 13.5min. no bleeding and complications after operation. Pseudo membrane completely off the 14days or so, the cure rate was 58.1%, the efficiency of 30.6%. ConclusionIn order to get a good curative effect, we should pay attention to the accurate diagnosis, choose the appropriate way of intubation and mouth opening device, pay attention to the details of the operation, maximize the effect of coblation to achieve a more minimally invasive treatment effect.

Diphtheria: Relic or relevant

Diphtheria is an acute localized infection of the throat associated with systemic manifestations caused by the toxin producing Corynebacterium diphtheriae. Diphtheria continues to remain a serious public health problem in children largely related to lack of effective immunisation. The grey, brown, and dirty pseudo membrane is pathognomonic of this disease. The exotoxin produced by the pathogen is responsible for systemic effects. Severity of infection is determined by site of infection, immunization status of the patient, and extent of systemic involvement. Airway obstruction, myocarditis, acute kidney injury, thrombocytopenia and neuropathy are some of the serious complications associated with this disease. Of these, myocarditis is the most dreaded complication and carries a very high mortality. Diphtheria is a clinical diagnosis and specific antitoxin is the mainstay of therapy and should be administered as early as possible. Antibiotics are used to eradicate residual organisms, stop toxin production and decrease infectivity. The indications for PICU transfer include severe pharyngo tonsillar disease, delayed presentation to hospital (> 5 days), delayed antitoxin therapy, signs of airway obstruction and/ormyocarditis. Extremes of ages, severe disease, unimmu- nized children, myocarditis and delayed administration of antitoxin are all poor prognostic factors.

Audit of pharyngeal pouch surgery in derby from 2007–2014, are we following nice guidance?

Audit of pharyngeal pouch surgery in derby from 2007–2014, are we following nice guidance?

Bull castration by method of total scrotal ablation

In this work, a 2 years and 10 months old bull, with 14 days history of wound on the right side of scrotum was presented. A painful swelling coated by grayish pseudo membranes of necrotic epithelium and fibrin was observed in right lateroventral portion of the scrotum. The presented data enabled us to make decision of performing the total scrotal ablation. The intention was to prevent the influence of probable resorbed necrotic tissue on the vital status of the patient.

Pseudomembranous conjunctivitis caused by Staphylococcus aureus

A 20-year-old female patient presented with complaints of redness, irritation, foreign body sensation, pain and excessive watering in the right eye since one month. On examination, conjunctiva was congested with pseudo membrane over the inferior fornix. Staphylococcus aureus was isolated from the conjunctival swab. Case was diagnosed as pseudomembranous conjunctivitis (PMC) caused by Staphylococcus aureus.