Rhino Orbital Cerebral Mucormycosis in settings of Covid-19 infection: A Case Series of Thirteen Patients

Abstract Background Rhino-Orbital-Cerebral Mucormycosis (ROCM) is an important infectious disease encountered in huge number in this recent post-covid 19 era. An alteration in defence immune system during covid-19 illness, in the presence of uncontrolled hyperglycaemia has led to the new epidemic of ROCM especially in developing nations like India. Method This case series of thirteen patients illustrates the various clinical presentation, laboratorical parameters, imaging features and outcome of patients of ROCM admitted in a tertiary care hospital in Northern India. Result In our case series, a total of 13 newly diagnosed cases of Rhino-Orbital-Cerebral Mucormycosis were studied. History of covid-19 illness was observed in 7 cases (53.8%), use of steroid during Covid-19 illness was seen in 5 cases (38.5%), oxygen therapy was given in 4 cases (30.8%). Co-morbid state in the form of diabetes mellitus was present in 12 cases (92.3%) with mean duration 16.69 months with an important finding of 6 cases (46.2%) having new-onset diabetes; hypertension in present in 3 cases (23.1%). Magnetic resonance imaging of paranasal sinuses showed involvement of multiple sinuses in all the 13 cases(100%), including maxillary and ethmoidal sinuses, with frontal in 12 cases (92.3%), sphenoidal in 11 cases (84.6%), symmetric in 9 cases (69.2%), mastoiditis in 4 cases (30.8%), maxillary space involvement in 4 cases (30.8%), palatal involvement in 1 case (7.7%). Multi-speciality approach treatment was given in the liposomal amphotericin B therapy in all the patients along with thorough endo-nasal debridement done in all cases, transcutaneous retrobulbar amphotericin B in 6 cases (46.2%) with exenteration done in 7 patients (53.9%). At 3 months of follow-up, there was substantial clinical improvement in all the cases. Conclusion There should be definite emphasis on high suspicion of mucor clinically for early diagnosis and aggressive management at initial state of diagnosis for better outcome. The need for sustained proper glycemic control during covid 19 era along with judicious use of steroid and public awareness for early symptoms and manifestations of mucor can curb the magnitude of such potentially opportunistic epidemic to a substantial rate. The longer the infection remains undetected, the greater the devastation ROCM can impose, of which blindness is an important hazard.

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A clinical and demographic profile of the cleft lip and palate in Sub-Himalayan India: A hospital-based study

Indian Journal of Plastic Surgery ◽

10.4103/0970-0358.96602 ◽

2012 ◽

Vol 45 (01) ◽

pp. 115-120 ◽

Cited By ~ 12

Author(s):

Jyoti Dvivedi ◽

Sanjay Dvivedi

Keyword(s):

Cleft Lip ◽

Cleft Lip And Palate ◽

Health Workers ◽

Tertiary Care ◽

Case Series ◽

Care Hospital ◽

Low Socioeconomic ◽

The Status ◽

Baseline Information ◽

History Of

ABSTRACT Objectives: To study the cleft lip and cleft palate in the poverty stricken Sub-Himalayan Garhwal region of India, being a commonly seen congenital abnormality and scarcity of studies about the demography of cleft in this region. Design: A prospective cohort observational case series was performed on 4657 cleft patients at a Tertiary care Hospital in Dehradun, India, over a period of 5 years. Outcome measures: The authors investigated the differences between age and sex with cleft status and family history of clefts, birth order, religion, socioeconomic status, parent literacy, source of information for treatment, haematological investigations showing the status of infection and coagulation in such children and satisfaction after treatment. Results: Seventy-two percent parents of cleft lip patients were illiterate, and only 8% were graduates, the majority of patients were from the low socioeconomic class. The siblings of 1.1% of the cleft patients had similar deformity. Anemia was seen in 83.16% cases which was commonly microcytic hypochromic type and eosinophilia was seen in 25.50% of cases. In the coagulation profile, International Nationalized Ratio was found to be raised in 52.12%. Almost 95% of the families were fully satisfied by the treatment and results. Conclusion: This study will provide baseline information on the status of these less privileged cleft patients in this mountainous region for future reference to health workers.

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Outcomes of pleural decortication in a tertiary care hospital of Telangana state

International Surgery Journal ◽

10.18203/2349-2902.isj20201059 ◽

2020 ◽

Vol 7 (4) ◽

pp. 1009

Author(s):

Madhusudan Kummari ◽

Amaresh Rao Malempati ◽

Surya S. Gopal Palanki ◽

Kaladhar Bomma ◽

Chakravarthy Goutham

Keyword(s):

Postoperative Complications ◽

Tertiary Care ◽

Care Hospital ◽

Medical Sciences ◽

Air Leak ◽

History Of ◽

The Common ◽

Lung Infections ◽

Surgery Outcomes

Background: The objective of the study was to study the clinical profile, incidence of postoperative complications in patients undergoing pleural decortication.Methods: The subjects for the study were selected from the cases admitted in a single unit of Department of Cardiothoracic Surgery, Nizam’s Institute of Medical Sciences, Hyderabad during the period of 2016 to 2018 and due ethics committee approval was taken. Collection of data is done from the database including admission record, ICU charts, discharge records and follow-up records. 50 patients underwent surgery. Outcomes and complications were analyzed for 3 years duration.Results: 50 patients were included in this study with different aetiologies that required pleural decortication. The average age of patients in our study was 34 years. Most patients in our study were male (80%) and had history of infection with tuberculosis (42%) and pyogenic (28%) infection. A few patients had history of trauma (12%). Most of the patients suffered from cough (88%), dyspnoea (74%), fever (82%) and haemoptysis (22%). The common postoperative complications we encountered were pleural air leak (37.5%) bleeding (25%) infection (25%) and recurrence (2%). Overall morbidity from pleural decortication was seen in 16 patients, and there was no mortality.Conclusions: The most common reason for pleural decortication is still empyema thoracis secondary to infection in the developing countries. Tuberculosis is still the most common cause leading to fibrothorax requiring pleural decortication followed closely by pyogenic lung infections and trauma.

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Mucormycosis due to Apophysomyces species complex- 25 years’ experience at a tertiary care hospital in southern India

Medical Mycology ◽

10.1093/mmy/myz081 ◽

2019 ◽

Vol 58 (4) ◽

pp. 425-433 ◽

Cited By ~ 2

Author(s):

Umabala Pamidimukkala ◽

Sukanya Sudhaharan ◽

Anuradha Kancharla ◽

Lakshmi Vemu ◽

Sundaram Challa ◽

...

Keyword(s):

Necrotizing Fasciitis ◽

Amphotericin B ◽

Species Complex ◽

Case Reports ◽

Tertiary Care ◽

Case Series ◽

Chronic Alcoholism ◽

Care Hospital ◽

Amphotericin B Deoxycholate ◽

Progressive Necrosis

Abstract Apophysomyces elegans species complex is an important cause of cutaneous mucormycosis in India. However, majority of those cases are reported as case reports only. We desired to analyze our patients with Apophysomyces infection reported over 25 years (1992–2017) to understand the epidemiology, management, and outcome of the disease. During the study period 24 cases were reported, and the majority (95.8%) of them presented with necrotizing fasciitis following accidental/surgical/iatrogenic trauma. One patient presented with continuous ambulatory peritoneal dialysis (CAPD) related peritonitis. Healthcare related Apophysomyces infection was noted in 29.2% patients. In addition to trauma, comorbidities were noted in 37.5% patients (type 2diabetes mellitus-6, chronic alcoholism-2, and chronic kidney disease-1). Of the 24 isolates, 11 isolates starting from year 2014 were identified as Apophysomyces variabilis by molecular methods. Majority (95.8%) of the patients were managed surgically with or without amphotericin B deoxycholate therapy, while one patient was treated with amphotericin B deoxycholate alone. Among 24 patients, seven (29.1%) recovered, six (25%) patients could not afford antifungal management and left the hospital against medical advice, and 11 (45.9%) patients died.The present case series highlights that necrotizing fasciitis caused by A. variabilis is prevalent in India, and the disease may be healthcare related. Although diagnosis is not difficult, awareness among surgeons is still limited about the infection, leading to a delay in sending samples to the mycology laboratory. Apophysomyces infection must be considered in the differential diagnosis in apatient with progressive necrosis of a wound who is not responding to antibacterial therapy.

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Clinical Characteristics and Outcome of Staphylococcus aureus Prostate Abscess From Ten Years of Experience at a Tertiary Care Center

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz372 ◽

2019 ◽

Vol 6 (10) ◽

Cited By ~ 1

Author(s):

Bryan Walker ◽

Eric Heidel ◽

Mahmoud Shorman

Keyword(s):

Staphylococcus Aureus ◽

Rare Complication ◽

Care Center ◽

Tertiary Care ◽

Care Hospital ◽

Risk Patients ◽

History Of ◽

A Site ◽

Lost To Follow Up

Abstract Objective Prostatic abscess (PA) is an uncommon infection that is generally secondary to Escherichia coli and other members of the Enterobacteriaceae family. In recent years, although rare, more reports of Staphylococcus aureus (S. aureus) PA have been reported, especially with increasing reports of bacteremia associated with injection drug use (IDU). Method This was a retrospective review of adult patients admitted to a tertiary care hospital between 2008 and 2018 and who had a diagnosis of S. aureus PA. Results Twenty-one patients were included. The average age was 46 years. Fourteen (67%) patients presented with genitourinary concerns. Main risk factors included concurrent skin or soft tissue infections (52%), history of genitourinary disease or instrumentation (48%), IDU (38%), and diabetes mellitus (38%). Methicillin-resistant Staphylococcus aureus (MRSA) was identified in 57% and concomitant bacteremia in 81% of patients. Surgical or a radiologically guided drainage was performed in 81% of patients. Antibiotic treatment duration ranged from 3 to 8 weeks. Six patients were lost to follow-up. Clinical resolution was observed in the remaining 15 (81%) patients who had follow-up. Conclusions S. aureus PA continues to be a rare complication of S.aureus infections. In most published reports, MRSA is the culprit. In high risk patients with persistent bacteremia, physicians need to consider the prostate as a site of infection.

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Umbilical endometriosis in a 42 years old parous woman: A Case Report

TAJ Journal of Teachers Association ◽

10.3329/taj.v28i1.39070 ◽

2018 ◽

Vol 28 (1) ◽

pp. 48-51

Author(s):

Mosammat Nargis Shamima ◽

Mohd Alamgir Hossain ◽

Shahela Jesmin ◽

Nargis Jahan ◽

Arpita Das

Keyword(s):

Case Report ◽

Tertiary Care ◽

Previous History ◽

Needle Aspiration ◽

Care Hospital ◽

History Of ◽

Needle Aspiration Cytology ◽

High Resolution Ultrasonography ◽

Umbilical Endometriosis

Endometriosis is a common gynaecological condition and presents mainly with involvement of the pelvic organs. However umbilical endometriosis is uncommon. A correct differential diagnosis can be difficult and the use of epiluminescence and MRI is suggested for the accuracy of preoperative diagnosis. This case report was experienced at a tertiary care hospital at Rajshahi. The patient was 42 years old multigravid woman presented with umbilical swelling and pain during menstruation for last 6 years with cyclical bleeding from the umbilical region for same duration. The patient had regular menstrual bleeding since the time of menarche. The patient had no previous history of endometriosis, dysmenorrhea or dyspareunia. Physical examination showed a hyperpigmented tender paraumbilical swelling with bloody discharge through umbilicus. Clinical examination together with the use of high resolution ultrasonography and fine needle aspiration cytology led to an accurate pre-operative diagnosis of umbilical endometriosis. The surgical approach to umbilical endometriosis represented an important step in achieving a satisfying result. The lesion to be excised and adequate umbilical repositioning was done. The patient was asymptomatic at the follow-up visit (12 months after surgery). A natural-looking umbilicus was observed with minimal visible scars.TAJ 2015; 28(1): 48-51

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Frequency of maternal & perinatal mortality and maternal morbidity among obstetrical patients referred with history of unattended pregnancy.

The Professional Medical Journal ◽

10.29309/tpmj/2021.28.01.5823 ◽

2021 ◽

Vol 28 (01) ◽

pp. 80-85

Author(s):

Amber Khawaja ◽

Fiza Ali Khan ◽

Asifa Abdul Jabbar ◽

Naeem Akhter Khokhar ◽

Saima Farook ◽

...

Keyword(s):

Maternal Mortality ◽

Perinatal Mortality ◽

Gestational Age ◽

Maternal Morbidity ◽

Tertiary Care ◽

Case Series ◽

Antenatal Visit ◽

Care Hospital ◽

Case Series Study ◽

History Of

Objective: To determine the frequency of fetomaternal morbidity and mortality among obstetric patients referred to tertiary care hospital with history of no antenatal visit. Study Design: Descriptive Case Series Study. Setting: Gambat Institute of Medical Sciences, Sindh Province. Period: June 2018 to December 2018. Material & Methods: About 175 pregnant females aged 18-35 years, having alive singleton pregnancy, gestational age >20-40 week without any history of obtaining antenatal care facility were included and followed-up till delivery and outcome were noted. Results: Mean age of females was 27.49 ± 4.46 years (18-35). Mean gestational age was 34.03 ± 4.07 weeks. About two third women (63%) were referred from rural areas. Maternal mortality rate was 12.6% while perinatal mortality was about 21.7%. Frequency of maternal morbidity of recorded as 34.9% case of hemorrhage, 36.6% case of anemia, 12.6% case of dystocia, 29.7% case of pre-eclampsia, 23.4% case of eclampsia & 19.4% case of sepsis. Maternal age was significant effect modifier for the frequency of pre-eclampsia, sepsis and maternal mortality (p<0.05). Conclusion: Maternal and perinatal morbidity & mortality are very high among women who have not attended the antenatal check-up. The major causes are haemorrhage, anaemia, pre-eclampsia/ eclampsia, dystocia and sepsis.

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Persistent Symptoms in Post-COVID-19 Patients Attending Follow-Up OPD at Sukraraj Tropical and Infectious Disease Hospital (STIDH), Kathmandu, Nepal

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6030113 ◽

2021 ◽

Vol 6 (3) ◽

pp. 113

Author(s):

Anup Bastola ◽

Richa Nepal ◽

Bikesh Shrestha ◽

Kijan Maharjan ◽

Sanjay Shrestha ◽

...

Keyword(s):

Tertiary Care ◽

Care Hospital ◽

Long Term Effects ◽

Persistent Symptoms ◽

History Of ◽

Polymerase Chain ◽

Disease Hospital ◽

Time Of Presentation

The long-term effects of COVID-19 among survivors is a matter of concern. This research aimed to study persistent symptoms in post-COVID-19 patients attending a follow-up clinic at a tertiary care hospital in Nepal. All patients, presenting to the outpatient clinic during the study duration of six weeks, with history of positive reverse transcriptase- polymerase chain reaction for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) at least two weeks prior to presentation, were included. The duration of follow-up ranged from 15 till 150 days with the mean duration of 28 days after diagnosis of COVID-19. Of 118 patients, 43 (36.4%) had a history of mild COVID-19, 15 (12.8%) had moderate, and 60 (50.8%) had severe. At the time of presentation, 97 (82.2%) patients reported that they had at least one persistent/new symptom beyond two weeks from the diagnosis of COVID-19. Dyspnea, fatigue, chest heaviness, and cough were the commonest persistent complaints in 48 (40.7%), 39 (33.1%), 33 (28%), and 32 (27.1%) patients, respectively. The findings in our study highlight the need for extended monitoring of post-COVID-19 patients following discharge, in order to understand and mitigate long-term implications of the disease.

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Outcome of significant pericardial effusion of infectious etiology in children: An observational retrospective cohort study

10.21203/rs.3.rs-556814/v1 ◽

2021 ◽

Author(s):

Dinesh Kumar ◽

Dheeraj Deo Bhatt ◽

Ankit Verma ◽

Ayub Ansari ◽

Vijay Grover

Keyword(s):

Pericardial Effusion ◽

Tertiary Care ◽

Treatment Protocol ◽

Current Treatment ◽

Pericardial Fluid ◽

Care Hospital ◽

Northern India ◽

Pericardial Diseases ◽

Infectious Etiology

Abstract Background: Information on outcome of paediatric pericardial diseases from India is limited. Aim: To study the outcome of significant pericardial effusion of infectious etiology in children.Setting and Design: Retrospective analysis of significant pericardial effusion of infectious aetiology in children admitted to a tertiary care hospital of northern India during the last 10 yearsResults: Of the 74 patients, 71.6% (53/74) had tuberculosis, most being “probable” tubercular effusion. Pyogenic cases (17/74) usually had a pleura-pulmonary focus. Pericardial fluid adenosine deaminase and CT chest were useful diagnostic aids in tubercular effusions. Pericardiocentesis and surgery were done in 72.9 % (54/74) and 12.1% (9/74) respectively. On median follow up of 18 months, death or chronic constrictive pericarditis was seen in 2 patients each, both had tubercular effusions. Conclusions: Tuberculosis is still the commonest infectious cause of pericardial effusion in children from this part of the world. Current treatment protocol has improved the outcome of this once deadly disease.

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Wies procedure for correcting involutional entropion of the lower lid in geriatrics

Malaysian Journal of Ophthalmology ◽

10.35119/myjo.v3i1.170 ◽

2021 ◽

Vol 3 (1) ◽

pp. 21-29

Author(s):

Erum Shahid ◽

Uzma Fasih ◽

Arshad Shaikh

Keyword(s):

Recurrence Rate ◽

Tertiary Care ◽

Case Series ◽

Successful Outcome ◽

Care Hospital ◽

Retrospective Case ◽

Geriatric Population ◽

Involutional Entropion ◽

Anatomic Results

Objective: To evaluate the anatomic outcome and recurrence rate of the Wies procedure for treating involutional entropion of the lower lid in geriatrics. Materials and methods: This retrospective case series was conducted in the Ophthalmology department of a tertiary care hospital from January 1, 2016 to December 31, 2017. Geriatric patients (≥ 65 years) who had undergone the Wies procedure, i.e., transverse lid split and everting sutures for correction of involutional entropion of the lower lid were included. All the surgeries were done under local anaesthesia by a single ophthalmologist. The follow-up period was 12 months. A successful outcome was defined as restoration of lid margin to its position with no lash touching the cornea and no recurrence within 12 months. Results: Eighteen eyes of 13 patients with a mean age of 67.6 ± 2.2 SD years were included. There were 11 males (61%) and 7 females (39%). Bilateral entropion correction was done in five patients. Nine right eyes and nine left eyes were included. Anatomical success was 94.4% at 12 months. Recurrence was seen in one (5.6%) patient at 12 months. Conclusion: The Wies procedure for correction of involutional entropion with horizontal lid laxity in the geriatric population provided good anatomic results in our study. The recurrence rate was minimal within 1 year. The recurrence rate can be reduced by an accurate initial entropion assessment.

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AUDIT OF MANAGEMENT OF ADULT CHOLEDOCHAL CYSTS

Pakistan Armed Forces Medical Journal ◽

10.51253/pafmj.v6i6.4476 ◽

2021 ◽

Vol 71 (6) ◽

pp. 1997-2000

Author(s):

Ammad Ud Din Nasir ◽

Muhammad Shoaib Khan ◽

Anas Bin Saif ◽

Qasim Butt ◽

Hanif Abbasi

Keyword(s):

Choledochal Cyst ◽

Operative Procedure ◽

Tertiary Care ◽

Case Series ◽

Military Hospital ◽

Type I ◽

Care Hospital ◽

Choledochal Cysts ◽

Cyst Excision

Objective: To analyze the complexity and diversity of type, surgical management and complications in adult choledochal cysts presenting to a Hepatobiliary unit of a tertiary care hospital. Study Design: Case series. Place and Duration of Study: Pak Emirates Military Hospital Rawalpindi, from Jan 2017 to Dec 2019. Methodology: All the patients diagnosed with choledochal cyst and underwent surgical procedure between Jan 2017 to June 2019 were analyzed. The clinical features, types, operative procedure and outcomes of the patients in terms of post-operative morbidity and mortality were assessed. Calvin Dindo classification was used to assess complications. Results: A total of 17 patients were studied, out of which, 13 were females (76.5%) and 4 were males (23.5%) with mean age of 37.41 ± 16.96 years. There were 13 type I (76.5%), 2 type IVa (11.8%) and 1 type II (5.9%) choledochal cysts according to Todani’s classification. Extrahepatic cyst excision with a Roux-en-Y hepatico-jejunostomy was performed on all 17 patients. There was no mortality in the series. Post-operative complications occurred in 4 (23.5%) patients, 2 were grade II, 1 was grade I and 1 grade III according to Clavin Dindo scale. Long-term follow up revealed recurrent cholangitis in 3 (17.6%) patients which settled on antibiotic regime. The median follow up time was 1.5 years. Conclusion: The total extra-hepatic excision with Roux-en-Y hepaticojejunostomy is the treatment of choice for adult choledochal cyst. The procedure has low morbidity and very low mortality.

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