Different types of mucormycosis: case series

Mucormycosis is the third invasive mycosis in order of importance after candidiasis and aspergillosis and is caused by fungi of the class Zygomycetes. The most important species causing Mucormycosis is Rhizopus arrhizus (oryzae). Identification of the agents responsible for mucormycosis is based on macroscopic and microscopic morphological criteria, carbohydrate assimilation and the maximum temperature compatible with its growth. The incidence of mucormycosis is approximately 1.7 cases per 1000 000 inhabitants per year. Clinical diagnosis of mucormycosis is difficult, and is often made at a late stage of the disease or post-mortem. We present here a series of five cases of different types of mucormycosis that were reported in our hospital till date. Of which three patients had good recovery and other two had a fatal outcome. Treatment of mucormycosis requires a rapid diagnosis, correction of predisposing factors, surgical resection or debridement as part of source control-and appropriate anti-fungal therapy. Liposomal amphotericin B is the drug of choice for this condition. The overall rate of mortality of mucormycosis is approximately 40%.

Interferon - ribavirin therapy for chronic hepatitis C: Efficacy in Saudi patients

Hepatitis C affects 2% of Saudi population. Previous local trails showed low response to interferon monotherapy for six- months. Aim: To evaluate biochemical and virological response of interferon- ribavirin combination on naive Saudi patients infected with HCV. A prospective single armed study was conducted at Riyadh Armed Forces Hospital from July 1999 to July 2002 for fifty patients who have hepatitis C virus [HCV-PCR] positive and chronic hepatitis on liver biopsy were started on the combination therapy for one year. All hads HCV-PCR at the end of therapy and at six months follow- up. Thirty-one patients [62%] normalized their ALT levels, and 25 patients [50%] became HCV- PCR negative achieving end- of-treatment response [ETR]. The sustained virological response [SR] was achieving in 19 patients [38%] at six months follow- up after stopping the treatment. Side effects were mainly flu like syndrome in 36 patients [72%]. Combination therapy of interferon afla-2b plus ribavirin is an effective treatment modality for HCV infected Saudi patients, with tolerable side effects. Our virological response rates are compatible with international published literatures

Accuracy of the triple test in the diagnosis of palpable breast masses in Saudi females

For patients who present to clinicians with palpable breast lesions, the "triple test:" [physical examination, mammography and fine-needle aspiration cytology] can be employed to provide accurate diagnosis. In this study, the sensitivity, specificity and predictive values of triple test components were studied separately and in combination. Material and During the study period [from January 1998 to December 1999], 140 patients with palpable breast masses were subjected to all components of the triple test followed by confirmatory open biopsy. Physical examination showed 82.6% sensitivity, 97.3% specificity and 86.4% positive predictive value. Mammography showed 87.5% sensitivity, 97.3% specificity and 87.5% positive predictive value and fine-needle aspiration cytology [FNAC] showed 91.7% sensitivity, 100% specificity and 100% positive predictive value in concordant cases [elements had either all malignant or all benign results]. The triple test was 100% accurate in the diagnosis of palpable breast lesions when all three elements were concordant. Based on these results, we recommend elimination of the confirmatory open biopsy, which will result in reduced expenses and morbidity compared with open biopsy

Effects of student examination stress on the blood and urine osmolality: a possible syndrome of inappropriate ADH [SIADH]

Serum Na[+], K[+], glucose, urea, osmolality, urine Na and osmolality were measured in university students subjected to examination stress. A total of 16 healthy subjects of the age range 19-23 were studied. The results showed significant decrease in serum osmolality attributed mainly to hyponatremia together with significant increase in urine Na[+] and osmolality. These results suggest an inappropriate secretion of antidiuretic hormone [ADH] as a result of emotional stress acting on the visceral brain [limbic and reticular activating systems]

Effect of bilateral truncal vagotomy on gallbladder motor response to cholecystokinin in vivo

The purpose of this work was to investigate the effect of bilateral truncal vagotomy on gallbladder smooth muscle response to cholecystokinin [CKK] and to compare it with the effect of combined vagotomy and atropine or hexamethonium pretreatment. According to previous studies CKK doses of 3 and 6 ng/kg/min. were considered physiological and doses between 12-36 ng/kg/min. were considered supraphysiological. Bilateral truncal vagotomy led to significant reductions in the increase in gallbladder pressure above its basal level, due to CCK doses of 3 and 6 ng/kg/min. The percentages of these reductions were 88% and 61%, respectively. Bilateral trumcal vagotomy,,however, did not cause any such reduction in gallbladder smooth muscle response to CCK doses between 12-36 ng/kg/min. combined atropine on hexamethonium pretreatment and bilateral vagotomy did not change the pattern or add to the degree of reducation in the increase in gallbladder pressure above its basal level in response to CCK physiological or supraphysiological doses. These results may show that surgical interference and pharmacological pre or postganglionic blockade of cholinergic innervation to the gallbladder have similar quantitative and qualitative inhibitory influence on gallbladder response to CCK physiological or supraphysiological doses