Sinonasal Mucormycosis in a Diabetic - Case Report

Background : Mucormycosis is one of the rapidly progressing and lethal form of fungal infection which involves the nose and paranasal sinuses of the head and the neck regions. It manifests as rhinocerebral, sinonasal, pulmonary, gastrointestinal, cutaneous or disseminated form. The underlying conditions can influence clinical presentation and often delay diagnosis, with resultant poor outcomes. Objective: To present and discuss the case of a diabetic patient with sinonasal mucormycosis presented with facial pain and discolouration of right side of nose and face due to mucormycosis. Case report: A 23 years old female patient presented to emergency with uncontrolled blood sugars, pain and swelling over right side of face and blackish discolouration of right side of nose. On examination, there was bluish black discolouration of skin over right side of dorsum of nose and right ala of nose and right nasal vestibule. Sinus CT scan showed features suggestive of fungal sinusitis. Mucormycosis was suspected, confirmed with biopsy and surgical debridement and medial maxillectomy done. Intravenous amphotericin B was administered for 21 days. The patient was followed up regularly, the disease appearing to be resolved. Conclusion: Mucormycosis is a rapidly progressive fatal infection mostly reported in immune-compromised individuals. Emergency multidisciplinary treatment for control of blood sugars, surgical debridement and effective antifungal medications gives better clinical outcome.

Neurological melioidosis presenting as intracranial abscess.

Melioidosis is an emerging disease in our country caused by the bacteria Burkholderia pseudomallei. Melioidosis can virtually affect any organ. It has varying clinical presentations ranging from pneumonia to fatal sepsis. Central nervous system (CNS) involvement in melioidosis is rare. We present a case of CNS melioidosis from South India. As the incidence of diabetes is increasing in our country varying manifestations of melioidosis will be seen in routine clinical practice. Melioidosis should be considered in the differential diagnosis of intracranial abscess and meningoencephalitis, especially in diabetics.

study of prevalence of thyroid dysfunction in patients with metabolic syndrome.

Background: The study was undertaken with an objective to study the thyroid functions in patients with metabolic syndrome diagnosed as per International Diabetes Federation (IDF) criteria and to know the spectrum of thyroid dysfunction. Methods: A total of 300 patients with metabolic syndrome diagnosed as per IDF criteria were included in the study. A detailed history regarding symptoms of hypothyroidism and examination was done in all patients and all these patients underwent thyroid profile tests. Results: A total of 300 patients with metabolic syndrome were included in this study. Thyroid dysfunction was present in 45% of the patients. Hypothyroidism was noted in 43 patients, subclinical hypothyroidism was noted in 114 patients, subclinical hyperthyroidism in 6 patients and hyperthyroidism in 1 patient. This study included 166 males and 134 females. 10% of the patients had symptoms related to hypothyroidism. 7% had goiter on examination. Thyroid dysfunction was seen in 68% females compared to that of 47% in males. Females had higher incidence compared to males. Elderly females (42%) and males in the age group of 40-50 years (41%) had higher incidence of subclinical hypothyroidism compared to others. Conclusions: Prevalence of thyroid disorders in diabetics was 45%. Elderly population had more incidences. Sub- clinical hypothyroidism was more common among females.

Florid cemento-osseous dysplasia: Review and report of two cases.

Only three Indian patients of florid cemento-osseous dysplasia have been reported (less than 2%), according to the review of recent literature (2003). This makes the occurrence of FCOD a relatively rare phenomenon. The age group may vary from 19-76 years and typically presents in the fourth and fifth decade. In most of the cases, patients do not have family history of the disease. We report two cases showing classic radiologic features. The diagnosis of our cases were made radiographically.

Clinical considerations in the diagnosis of autism spectrum disorders.

The diagnosis of autistic spectrum disorders (ASD) is being made more frequently in children and at younger ages. This paper discusses various factors to be considered in the screening of autism, early features of presentation, relevant to assessment and diagnosis, subtypes or different syndromes within the spectrum of autistic conditions including Asperger syndrome, the differential diagnosis from learning and language disorders and the medical and behavioural commonly associated disorders.

Pharmacotherapy of target symptoms in autistic spectrum disorders.

There are no aetiologically-based treatments available to cure autism. Though psychotropics have a role in the management of some symptoms of autism, clinical trial evidence for the use of psychotropics is in its infancy and needs close monitoring. About half of the subjects with high functioning pervasive developmental disorders (PDDs) are currently reported to be on psychotropics (anti-depressants, stimulants and antipsychotics), with many of them being on anti-epileptic medication simultaneously. Despite this high level of psychotropic use, few studies exist investigating the pharmacokinetics, pharmacodynamics or side-effect profiles in this population. Multiprofessional and parent partnership is essential in managing autism and psychopharmacology should be used in conjunction with environmental manipulation, educational modification and/or behavioral management strategies. A symptomatic approach to managing the difficult behaviours associated with autism is recommended. Some symptoms of autism may be medication responsive (hyperactivity, obsessions, rituals, inattention, tics, etc), while other symptoms may be responsive to behavioural interventions, but may require medication (aggression, anxiety, depression, impulsivity, sleep difficulties, etc), and symptoms which need specific skill remediation are usually non-responsive to medication (deficits in academic, social or sport domains). The new atypical antipsychotics (such as risperidone, olanzapine, amisulpiride, quetiapine) and SSRIs are increasingly being used in autism, with encouraging results, but a risk-benefit ratio of pharmacotherapy is essential with due weight being given to the side-effects of medication. Despite symptomatic improvement with medication, one should remain cautious about long-term use of psychotropics. It is also important to recognize that psychotropics can sometimes worsen behaviour, and can produce iatrogenic symptoms. Certain anti-epileptic medication and psychotropic drugs are metabolized by the same cytochrome P450 isoenzymes in the liver. In such circumstances, the addition of a psychotropic agent may drastically alter the levels of the anti-epileptic medication and vice versa. It is suggested that specialist clinics should be involved when one is considering complex medication regimes, experimental drugs, polypharmacy, or if patients show unusual side-effects or is drug resistant.

Study of coagulase negative staphylococci isolated from blood and CSF cultures.

Coagulase negative Staphylococci (CONS) which were considered as laboratory contaminants and normal flora of skin in man, have emerged as opportunistic pathogens. The infection with CONS has been reported since 1950 with increasing frequency and has been implicated as the causative agents of certain categories of patients viz, neonates with sepsis, cardiac patients with prosthetic valves, immunocompromided patients which include end-renal stage disease, and renal transplantation, burns and cancer patient. These are causing problems to clinicians because of their drug resistance. 180 strains of CONS isolated from blood and CSF during the period of 2 years (Jan 1997-Dec 1998) were studied. Not only they were resistant to Penicillin (P), Ampicillin, (Amp), Oxacillin (Ox), but also developing resistance to Vancomycin (Van) which pose a therapeutic problem. So this study was undertaken and this area needs further exploration.