Phaeohyphomycosis: A study from tertiary health care center in North India

Objectives: Phaeohyphomycosis refers to infections caused by phaeoid/dematiaceous or darkly pigmented fungi. This study was undertaken to further increase our knowledge about the incidence of phaeohyphomycosis and its causative agents. Materials and Methods: The present study was conducted over a period of one and a half years (January 2018–June 2019) on specimens received from patients with varied clinical manifestations ranging from superficial infections, subcutaneous cysts, pneumonia, brain abscess to a disseminated infection. These specimens were processed in the Department of Microbiology for potassium hydroxide (KOH) examination and culture and in Pathology for cytology/histopathological examination (HPE). All specimens positive on direct examination for dark grey, brown or black fungi were included in the study. Results: A total of 20 specimens were confirmed as phaeohyphomycosis. Most of the patients belonged to the age group of 41 to 50 years. Male: Female ratio was 2.3:1. Trauma was the most common risk factor. Spectra of the isolated fungal pathogens comprised of Bipolaris species, Exophiala species, Curvularia geniculata, Phialemonium species, Daldinia eschscholtzii, Hypoxylon anthochroum, Phaeoacremonium species, Leptosphaerulina australis, Medicopsis romeroi, Lasiodiplodia theobromae, Eutypella species, Chaetomium globosum, Alternaria species, Cladophialophora bantiana and 2 unidentified dematiaceous fungi. Recovery from phaeohyphomycosis was seen in 12 patients, 7 were lost to follow up and one patient succumbed to the illness. Conclusion: Infections caused by phaeoid fungi can no longer be viewed as rare. In fact, phaeohyphomycosis can have myriad of presentations spanning from mild cutaneous infections to fatal brain disease. Therefore, a high index of clinical suspicion is needed to diagnose such infections. The primary treatment modality remains surgical removal of the lesion in cutaneous or subcutaneous infections however disseminated disease with a guarded prognosis requires aggressive management.

A comparative study of tracheal intubation characteristics using Macintosh and Airtraq laryngoscope.

Background: Direct laryngoscopy for endotracheal intubation with the Macintosh blade is most commonly used for establishing a patent airway. AirtraqTm Optical Laryngoscope, does not require the alignment of the 3 airway axes for glottic visualization. Objective: We aim to compare these two laryngoscopes in view of laryngoscopic grading, ease of tracheal intubation and hemodynamic changes associated with laryngoscopy and intubation. Materials and Methods: 50 ASA I and II patients were randomly divided into Macintosh (M) group and Airtraq (A) group. Cormack Lehane grading, ease of intubation, laryngeal intubation time in secs and incidence of sore throat was noted. HR & BP was recorded at 0, 1, 3, 5 & 10 minutes following intubation. Unpaired ‘t’ test compared inter-group data, while paired ‘t’ test compared within group cardiovascular data. (p<0.05 statistically significant) Results: The demographic data of both groups were comparable. Cormack- Lehane grading was better in group A than in group M [grade I group A(84%) and group M(60%)]. The mean time for laryngeal intubation (Mean ± SD) for group A (8.3 ± 4.6 secs) and group M (20.46 ± 6.6 secs) (t = 7.6, p< 0.01). Ease of intubation was better in group A than group M. The rise in blood pressure and heart rate was significantly less in Group A as compared to Group M. Conclusion: Airtraq laryngoscope was superior to Macintosh laryngoscope as it provided better laryngoscopic views, shorter laryngoscopy and intubation time, easier intubation and the rise in heart rate and systolic blood pressure was significantly less.

Leprosy among adolescents in Kolkata, India.

Leprosy, manifesting during adolescence when significant physical and emotional changes are taking place, poses further stress and strain both on the individual and on the family. Based on hospital records, focus group discussions and in-depth interviews, data on 258 adolescent leprosy patients seen at a leprosy referral hospital in Kolkata, India, are presented. The male-female sex ratio was 1.93:1, 56.6% were multibacillary patients and 13.2% had grade 2 disability. At the time of final follow up, 10% of PB and 33% of MB patients had already discontinued treatment. The commonest complication was reaction (14.5%). Adolescents were still dependent on their parents for health matters. Data obtained from questionnaires confirmed the role of social stigma in hiding, delay in starting of MDT and defaulting. Frequent hospital admissions resulted in loss of jobs and disruption of studies and caused psychological disturbances. It is critical to identify and treat adolescent leprosy on a priority basis. Health education and counselling programmes must be more focused and acceptable. Further research is necessary.

Multifocal giant cell tumour of bone in a skeletally immature patient--a case report.

Giant cell tumor of bone is usually seen in adults affecting a single bone. Multiple giant cell tumour of bone occurring in skeletally immature patients is extremely rare. Multifocal giant cell tumor of bone in a ten year old boy involving upper end of humerus and tibia is being reported for its extreme paucity in literature.

Factors regulating the metastatic potential of benign giant cell tumour of bone--study of an unusual case with short review of literature.

Benign giant cell tumour of bone with metastases to other bones and lungs is extremely rare. Benign metastasising giant cell tumour is distinctly separate from multicentric giant cell tumour, primary and secondary malignant giant cell tumour. Factors regulating the local recurrence and metastatic potential of this benign tumour depend on its aggressiveness which can be better assessed by clinical and radiological parameters rather than the histopathological appearance. A benign giant cell tumour of ischium with metastasis to vertebra and lung over an eleven year period is discussed. Extreme paucity of literature prompted to publish the article. A short review of factors determining the recurrence and metastatic spread of benign giant cell tumour of bone is highlighted.

Primary malignant giant cell tumour of bone--a study of two cases with short review.

Primary malignant giant cell tumour of bone is extremely rare. It is distinctly separate from benign metastasising giant cell tumour of bone and secondary malignant giant cell tumour which occurs in response to radiotherapy and repeated curettage of benign giant cell tumor. The tumor has high mortality rate. It usually affects lower end of femur and upper end of tibia. Two usually affects lower end of femur and upper end of tibia. Two cases, on involving upper end of tibia and other in vertebra are discussed. Extreme paucity of literature prompted to publish this article. A short review of radiological appearance, histopathological findings and treatment modalities is highlighted.

Treating congenital hypothyroidism: maximum age limit up to which a socially compatible child is expected.

It is has been known that the treatment with thyroxine in hypothyroid children results in normal physical growth, but mental development is less predictable. A comparative study of developmental milestones, anthropometry and intelligence quotient (IQ) in congenital hypothyroid children starting thyroxine therapy before and after 6 months of age was done. Forty-eight congenital hypothyroid children were enrolled. They were given thyroxine and were followed up. In 18 cases who received thyroxine at or before 6 months of age their anthropometric measurements in majority were 50th percentile or above. Their mental age was deficient on an average by 5 months as compared to chronological age and their IQ was above 85. In rest of 30 cases where thyroxine was started after 6 months of age anthropometric measurements in majority were less than 50th percentile. Their mental age was deficient on an average by 14 months with IQ ranging between 50 and 70. Thyroxine therapy before 6 months of age considerably improved mental function so that they are educable. On the contrary those with late thyroxine therapy showed mild to moderate mental retardation and need special care. In developing country like ours if treatment of hypothyroidism can be started even by 6 months of age considerable brain function can be salvaged so that they can attain a self supportive life.