scholarly journals A RETROSPECTIVE STUDY OF RHINO-ORBITAL MUCORMYCOSIS

2021 ◽  
pp. 55-59
Author(s):  
S. Srinivasan ◽  
P. Divya ◽  
A. Rohini ◽  
R. Jayapreethi
Keyword(s):  
Risk Factors ◽  
Retrospective Study ◽  
Fungal Infection ◽  
Vision Loss ◽  
Central Retinal Artery Occlusion ◽  
High Dose ◽  
Nasal Discharge ◽  
Common Symptom ◽  
Uncontrolled Diabetes ◽  
Orbital Pain

BACKGROUND: Mucormycosis is a rapidly progressing, life threatening, opportunistic fungal infection caused by angioinvasive mucorales species of the phylum zygomycetes.The major risk factors of the disease are uncontrolled diabetes mellitus, COVID-19 infection,prolonged usage of high dose of systemic corticosteroids,immunocompromised status and neutropenia. These create a nidus for fungal infection through nasal mucosa which spreads up through paranasal sinuses into orbit manifesting as rhino-orbital mucormycosis. AIM 1. To study the epidemiology and various clinical patterns of presentation of rhino-orbital mucormycosis in post covid patients. 2. To analyse the risk factors associated with progression of rhino-orbital mucormycosis in post covid patients. METHODS: A retrospective study of 25 patients diagnosed as rhino-orbital mucormycosis in post covid patients at Government Kilpauk Medical College Hospital between April and July 2021 was done. RESULTS: In our study,males (64%) are more commonly affected with age preponderance of 51-60 years(28%). The mean age of presentation was 52.1+/-4.49years.The most common symptom of the disease is nasal discharge with sinus and orbital pain(52%).The most common form of presentation is orbital apex syndrome in seven patients(28%).Five patients had loss of vision, of which four were due to central retinal artery occlusion(16%) and one due to cavernous sinus thrombosis.MRI imaging of these patients showed sinus involvement(100%) in all cases ,orbital(48%) and cerebral involvement(8%).The major risk factors responsible for progression of disease in our study are uncontrolled diabetes, prolonged usage of high dose steroid therapy, medial wall involvement, optic nerve head involvement and artery thrombosis. CONCLUSION: Post covid patients presenting with nasal discharge with sinus and orbital pain symptoms need to be diagnosed and managed properly to avoid spread of infection and fatal complications. Aggressive surgical debridement of infected tissues helps in increasing the survival rate of the patients. Patients with risk factors need to be closely monitored to prevent vision loss and cosmetic disfigurement surgeries.

Prophylaxis and treatment of patients with aspergillosis: an overview, including the Royal Melbourne Hospital experience

2002 ◽  
Vol 49 (suppl_1) ◽  
pp. 75-80 ◽  
Author(s):  
Andrew Grigg
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Fungal Infection ◽  
Antifungal Prophylaxis ◽  
Resistant Organism ◽  
Prior History ◽  
High Dose ◽  
Allogeneic Bone ◽  
Royal Melbourne Hospital ◽  
Aspergillus Sp

Abstract Patients receiving allogeneic bone marrow transplants are at risk of developing Aspergillus infections. The pre-transplant risk factors for the development of invasive disease include prolonged neutropenia, colonization with Aspergillus sp. or a prior history of fungal infection. Post-transplant risk factors include severe graft-versus-host disease with concomitant high-dose corticosteroid therapy, and colonization with Aspergillus sp. The antifungal prophylaxis of selected high-risk pre-transplant patients at the Royal Melbourne Hospital includes granulocyte transfusions and AmBisome. In high-risk patients post-engraftment, prophylaxis consists of oral itraconazole, or if it cannot be tolerated, AmBisome. Antifungal prophylaxis is discontinued upon resolution of neutropenia, when prednisolone dose falls below 10 mg/day or when Aspergillus colonization disappears. Following this regimen, there has been only one death due to fungal infection in over 80 consecutive allograft patients. This patient was infected with an amphotericin B-resistant organism.

scholarly journals Risk Factors and Mortality of Carbapenem-Resistant Klebsiella Pneumoniae Bloodstream Infection in a Tertiary-Care Hospital in China: An Eight-Year Retrospective Study

2020 ◽  
Author(s):  
Jie Chen ◽  
Hua Ma ◽  
Yongfeng Li ◽  
Michal Mastalerz ◽  
Ting Sheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Septic Shock ◽  
Severe Sepsis ◽  
Retrospective Study ◽  
Combination Therapy ◽  
Antimicrobial Therapy ◽  
Hematologic Malignancies ◽  
Mortality Rates ◽  
High Dose ◽  
Carbapenem Resistant

Abstract Background: The prevalence of carbapenem-resistant Klebsiella pneumonia bloodstream infection (CRKP-BSI) is increasing worldwide. CRKP-BSI is associated with high rates of morbidity and mortality due to limited antibiotic choices. Here, we aim to identify the prevalence and risk factors for infection and mortality of CRKP BSI. Methods: This was a retrospective study of the past data from January 1st, 2012 to December 31st, 2019 of adult patients with KP-BSI in Xiangya Hospital, China. Data from Demographic and clinical findings were retrieved from medical records. Results: Among the 706 incidences included in this study, 27.4% of them (212 / 753) being CR-KP strains. The occurrence of CRKP-BSI was increased from 20.69 to 37.40% from 2012 to 2019. Hematologic malignancies (P<0.001 , odds ratio [OR] 4.68, 95% confidence interval [CI] 2.3–9.4) and ICU acquired infection (P=0.003 , OR 2.10, 95% CI 1.3–3.4) were identified to be substantial risk factors of carbapenem resistance. The overall 28-day mortality rates of CRKP-BSI patients was significantly higher than that of CSKP-BSI (P<0.001). Logistic regression analysis identified severe sepsis or septic shock incidents (OR, 8.44; 95% CI, 1.85–38.39), inadequate empirical antimicrobial therapy (OR, 15.01; 95% CI, 3.70–60.79) and corticosteroids use preceding infection onset (OR, 6.45; 95% CI, 1.12–37.08) as the independent predictors of 28-day mortality of CRKP-BSI patients. However, high dose carbapenem combination therapy was identified as anticipated factors of low 28-day mortality (OR, 0.11; 95% CI, 0.03–0.51).Conclusion: The occurrence of CRKP-BSI was significantly increased during the study period. Hematologic malignancies and ICU acquired infection were associated with the development of CRKP BSI. Severe sepsis or septic shock incidents, inadequate empirical antimicrobial therapy and corticosteroids use preceding infection onset caused significant increase of mortality rates in CRKP-BSI patients. High dose carbapenem combination therapy was associated with better outcome.

Demographics, treatment, and outcome of retinoblastoma: A large series with protocol-based management.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 9568-9568
Author(s):  
Vijay Anand Palkonda Reddy ◽  
Santosh Honavar ◽  
Puthiyapurayil M Fairooz ◽  
Mohammed Javed Ali ◽  
Geeta K Vemuganti
Keyword(s):  
Risk Factors ◽  
Vision Loss ◽  
Treatment Protocol ◽  
Case Series ◽  
Developed Countries ◽  
Focal Therapy ◽  
External Beam Radiation ◽  
High Dose ◽  
Beam Radiation ◽  
Advanced Tumors

9568 Background: Retinoblastoma is the most common primary intraocular malignancy of childhood with incidence of 1 in 20,000 and the third most common pediatric cancer. In the previous decades, early diagnosis and treatment of retinoblastoma have improved survival rates in developed countries. Nevertheless, protocol based management help reduce the mortality rate associated with advanced tumors. The purpose of the study is to report demographics, management, and outcome of retinoblastoma in the Ocular oncology centre of South India. Methods: Consecutive case series of 1,543 eyes of 1,067 patients with 22 years of follow-up. Demographics, clinical features, treatment and outcome (survival, organ salvage and function salvage) were analyzed. Management comprised of focal therapy for small tumors, standard triple drug chemoreduction for larger (>4mm) tumors, high dose chemoreduction and periocular chemotherapy for vitreous seeds, and enucleation for advanced tumors. Adjuvant therapy was provided in patients with histopathologic high-risk factors for systemic metastasis. Orbital retinoblastoma was managed with a multimodal treatment protocol. Results: Sixty-six percent were <3 years of age. Forty-five percent were bilateral. Symptoms were leucocoria (33%), vision loss (10%), proptosis (6%), and squint (6%). The tumor was intraocular in 94% and orbital in 6%. Management was by protocol and included enucleation (52%), chemoreduction (26%), focal therapy (11%), and external beam radiation (5%). Fifty-five percent of enucleated patients had histopathologic risk factors for metastasis and received adjuvant chemotherapy. Chemoreduction with focal therapy resulted in eye and vision salvage in 92%. Overall, 94% survived. Conclusions: Protocol-based management of retinoblastoma provides excellent prognosis for survival, eye salvage and vision salvage.

scholarly journals Incidence and Risk Factors of Invasive Fungal Infection in Adult Patients Receiving Allogeneic Hematopoietic SCT Recipients

Blood ◽  
2014 ◽  
Vol 124 (21) ◽  
pp. 2476-2476
Author(s):  
Yao-Chung LIU ◽  
Jyh-Pyng Gau ◽  
Cheng-Hwai Tzeng
Keyword(s):  
Risk Factors ◽  
Fungal Infection ◽  
Invasive Fungal Infection ◽  
Chronic Gvhd ◽  
Prior History ◽  
High Dose ◽  
Hematopoietic Stem ◽  
Post Transplant ◽  
Blood And Marrow Transplantation ◽  
History Of

Abstract To investigate the incidence and risk factors for the occurrence of proven or probable invasive fungal infection (IFI) in adult patients receiving allogeneic hematopoietic stem cell transplantation (HSCT), 421 patients undergoing HSCT between 2002 and 2013 in our hospital were retrospectively analyzed. Thirty-one patients with the median age of 42 years (range: 19-60) developed IFI after HSCT. The post-HSCT IFI incidence was 7.4% and median time from HSCT to the diagnosis of IFI was 139 days (range: 2-1809). The risk factors for the occurrence of IFI were analyzed using Cox regression models.Of the pretransplant factors, European Group for Blood and Marrow Transplantation (EMBT) risk>2 (P=0.001) and prior history of IFI (P=0.006) or DM (P=0.042) were the significant predictors for post-HSCT IFI by univariate analyses. In multivariate analysis, EMBT risk>2 (P=0.015) and prior history of IFI (P=0.006) retained significance. Of the post-transplant factors, acute graft-versus-disease (aGVHD) overall grade III-IV (P<0.001), extensive chronic GVHD (cGVHD) (P=0.002), post-transplant lymphoproliferative disorders (PTLD) (P=0.005) and the use of high-dose steroids (P<0.001) were statistically significant in univariate analyses. After multivariate analysis, high-dose steroids (P<0.001) and aGVHD overall grade III-IV (P=0.045) retained significance. These results suggest that risk group stratification prior HSCT and monitoring of IFI in patients with severe GVHD and receiving high-dose steroids is mandatory to decrease the risk of post-HSCT IFI, especially in those with prior history of IFI. Abstract 2476. Table 1.Possible factors for the occurrence of invasive fungal infection (IFI) after adult allogeneic HSCTIFIUnivariate analysisMultivariate analysisFactorsNo. of patientsN%HR95%CIP-valueHR95%CIP-valueEMBT risk=<216952.9>22522610.35.0381.930-13.1510.0013.3901.273-9.0290.015Prior history IFINo406276.6Yes15426.64.4571.551-12.8060.0065.8071.675-20.1290.006Prior history DMNo402286.9Yes19315.73.4901.045-11.6530.042aGVHDNo or Overall Gr. I-II379236.0Gr. III-IV42819.06.9363.046-15.796<0.0012.6271.023-6.7480.045High steroids*No367123.2Yes541935.111.1485.401-23.008<0.00111.1853.875-32.289<0.001cGVHDNo or limited364195.2Extensive571221.03.1311.518-6.4590.002PTLDNo405276.6Yes164254.6271.607-13.3200.005Abbreviations: CI = confidence interval; HR = hazard ratio; EBMT = European Group for Blood and Marrow Transplantation; HSCT = hematopoietic stem cell transplantation; GVHD = graft-versus-host disease; aGVHD = acute GVHD; cGVHD = chronic GVHD; Gr.= grade; PTLD = Post-transplant lymphoproliferative disorders. DM = Diabetes mellitus. High steroids* = post-HSCT high-dose steroid; Significant values (P<0.05) are given in bold. Figure 1 Incidence of post-HSCT IFI per year Figure 1. Incidence of post-HSCT IFI per year Figure 2 Overall survival of the patients with IFI Figure 2. Overall survival of the patients with IFI Disclosures No relevant conflicts of interest to declare.

scholarly journals Early incidence of glucocorticoid-induced diabetes in patients with brain tumors: a retrospective study of the first 7 days of treatment

2017 ◽  
Vol 5 (3) ◽  
pp. 170-175
Author(s):  
Helga Schultz ◽  
Birthe Krogh Rasmussen ◽  
Peter Lommer Kristensen ◽  
Andreas Kryger Jensen ◽  
Ulrik Pedersen-Bjergaard
Keyword(s):  
Risk Factors ◽  
Brain Tumor ◽  
Retrospective Study ◽  
Brain Tumors ◽  
High Dose ◽  
Laboratory System ◽  
Glucose Levels ◽  
Effect Of Treatment ◽  
Using Data ◽  
Information Bank

Abstract Background Hyperglycemia or diabetes is a well-known side effect of treatment with glucocorticoids. In patients with brain tumors, glucocorticoids are widely used to treat symptoms of peritumoral edema. We conducted a retrospective study of patients with suspected brain tumor to determine the incidence of and risk factors for glucocorticoid-induced diabetes. Methods This was a retrospective study of patients referred with suspected brain tumor to a neurological department, using data from a clinical database, electronic medical records, the laboratory system, and the pathology information bank. . Nondiabetic patients with a neuroimaging-verified brain tumor treated with high-dose glucocorticoid and monitored with glucose measurements were included in the study. Results Among 809 patients referred with suspected brain tumor, 171 were eligible for the study. Thirty-eight (22%) patients developed glucocorticoid-induced diabetes, defined as 2 glucose measurements ≥200 mg/dl (11.1 mmol/l) within the first week of treatment, and 4 of the patients were treated with insulin. The majority of patients with glucocorticoid-induced diabetes were identified on days 2, 3, and 4, and glucose levels were highest in the afternoon and evening. We were not able to identify any risk factors for glucocorticoid-induced diabetes and glucocorticoid-induced diabetes had no influence on survival in our cohort. Conclusions Glucocorticoid-induced diabetes is frequent in the first 7 days of treatment in patients with brain tumors. The results emphasize the need for screening for glucocorticoid-induced diabetes in this group of patients to avoid comorbidity expected to arise from hyperglycemia.

Prediction of systemic fungal infection in allogeneic marrow recipients: impact of amphotericin prophylaxis in high-risk patients.

1994 ◽  
Vol 12 (4) ◽  
pp. 827-834 ◽  
Author(s):  
M R O'Donnell ◽  
G M Schmidt ◽  
B R Tegtmeier ◽  
C Faucett ◽  
J L Fahey ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fungal Infection ◽  
Amphotericin B ◽  
Low Dose ◽  
Fungal Infections ◽  
High Dose ◽  
Gvhd Prophylaxis ◽  
Increased Risk ◽  
Grade Ii ◽  
Allogeneic Marrow

PURPOSE To identify risk factors that might predict for systemic fungal infections in marrow transplant recipients within the first 100 days and to assess the efficacy of low-dose amphotericin B used as prophylaxis for candidemia and infection with invasive Aspergillus species in patients at risk. PATIENTS AND METHODS A retrospective analysis of transplant outcomes for 331 allogeneic marrow recipients transplanted between 1983 and 1989 was performed to identify patients who might be at increased risk of fungal infection. Factors analyzed included disease, remission status, transplant regimen, graft-versus-host disease (GVHD) prophylaxis, duration of neutropenia, and development of GVHD. A trial of low-dose amphotericin (5 to 10 mg/d) begun on day +1 and continuing for 2 to 3 months posttransplant was begun in 1987 to evaluate its utility in reducing systemic mycoses. RESULTS There were 18 episodes of candidemia and 18 systemic mycoses documented by blood or tissue culture or by biopsy. The initiation of high-dose (0.5 to 1 mg/kg/d) corticosteroids early as a component of GVHD prophylaxis in 1986 was identified as the most important risk factor for fungal infections, with a sixfold increase in infections as compared with the previous GVHD regimen (P < .0001); this was despite a significant decrease in the incidence of grade II to IV GVHD (7% v 43%; P = .0001). Low-dose amphotericin B initiated before the start of high-dose corticosteroid GVHD prophylaxis reduced the incidence of fungal infections from 30% to 9% (P = .01) without renal toxicity. Cyclosporine levels were lower in the patients who received amphotericin, leading to an increase in the rate of GVHD to 19% (P = .02). Controlling for GVHD prophylaxis, prolonged neutropenia (P = .00), and grade II to IV GVHD (P = .01) were also identified as risk factors for fungal infection. CONCLUSION Amphotericin B can be used in low doses as prophylaxis for fungal infections early in the posttransplant course. However, cyclosporine doses need to be monitored to maintain target levels.

Prevalence and Risk Factors of Hepatitis C Virus (HCV) in Tehsil Batkhela District Malakand, KPK, Pakistan

2018 ◽  
Vol 9 (06) ◽  
pp. 20251-20256
Author(s):  
Mudassir Khan ◽  
Shahrukh Khan ◽  
Shohra Haider ◽  
Fazal Jalil ◽  
Muhsin Jamal ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hepatitis C Virus ◽  
Hepatitis C ◽  
Skin Color ◽  
Significant Risk ◽  
Rapid Test ◽  
Prevalence Ratio ◽  
Hcv Infection ◽  
Hcv Rna ◽  
Common Symptom

Background: Prevalence of Hepatitis C viral infection and its major risk factors has been found out in population of Batkhela, Khyber Pakhtunkhwa, Pakistan by taking number of volunteers from the interested area. HCV prevalence has not been researched in recent time here in this area, so that’s why we contributed. Materials and Methods: Ab rapid test cassette serum/plasma (USA) kit has been used for the mentioned purpose following by ELISA and finally PCR to find out active infection of virus. ICT positive individuals were reconfirmed by ELISA and then ELISA positive samples were carefully investigated by RT-PCR for Hepatitis C Virus. Results: The study population was of 770 volunteers belonging to the mentioned area of research, 453 males and 317 females. The overall prevalence was found to be 5.32% of HCV in Batkhela. This prevalence ratio was 3.12% in males and 2.20 % in females. 3rd generation ELISA was used to refine ICT positive samples which showed that 37 of the ICT positive samples had antibodies detected by ELISA. To find out active HCV infection, ELISA positive samples were refined by real time PCR which showed 2.98% of prevalence of active HCV infection in Batkhela based on HCV RNA in their blood. Principle Conclusion: Overall prevalence was found 5.32%, contaminated reused syringes and blades at Barbour’s shop, blood transfusion, surgical operations and unhygienic food in stalls etc were found significant risk factors for acquiring HCV infection. Body weakness and pale yellow skin color was common symptom in HCV positive volunteers. Safe sexual activities, blood screening before donation and sterilizing surgical equipment’s can protect us from Hepatitis C Virus.

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