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Aim: A series of cases have been presented involving the oral cavity focusing on the presentation, diagnosis and treatment of mucormycosis that can form a basis for successful therapy. Background: The management of severe coronavirus disease (COVID-19) in conjunction with comorbidities such as diabetes mellitus, hematological malignancies, organ transplants, and immunosuppression have led to a rise of mucormycosis which is an opportunistic infection. Cases Description: The various forms that have been enlisted till date are rhino-cerebral, rhino-orbital, gastrointestinal, cutaneous, and disseminated mucormycosis. From the dentistry and maxillofacial surgery perspective, the cases depicting extension of mucormycosis into the oral cavity have been less frequently recorded and thus, require a detailed study. The patients that reported to our private practice had non-tender swelling, draining sinuses and mobility of teeth. A similarity was observed in the clinical signs both in osteomyelitis and mucormycosis. Thus, a histopathological examination was used to establish the definitive diagnosis. Conclusion: Mucormycosis is a life threatening pathology that requires intervention by other branches to make an early diagnosis and commence the treatment. The characteristic ulceration or necrosis is often absent in the initial stage and thus, histopathological examination and radiographic assessment are required to formulate a definitive diagnosis. Early intervention is a necessity to avoid morbidity. The treatment involves surgical debridement of the necrotic infected tissue followed by systemic antifungal therapy. Mucormycosis has recently seen a spike in its prevalence, post the second-wave of coronavirus pandemic in India. It was seen commonly in patients with compromised immunity, diabetes mellitus, hematological malignancies, or on corticosteroid therapy. Mucormycosis invading the palate mostly via maxillary sinus has been less frequently described. In the post-COVID era the features associated with mucormycosis involving oral cavity, should warrant a possible differential diagnosis and managed appropriately. (AU)
Objetivo: Apresentar uma série de casos com enfâse na apresentação, diagnóstico e tratamento da mucormicose oral, assim como uma revisão sistemática que sirva como base para estabelecimento de terapias de sucesso. Introdução: A forma severa da infecção por coronavirus (COVID-19) associada a diabetes mellitus, doenças hematológicas malignas, transplante de órgãos e imunossupressão levaram a um aumento das infecções oportunistas de mucormicose. Descrição dos Casos: As diversas apresentações clínicas que foram descritas até o momento são a rinocerebral, rino-orbital, gastrointestinal, cutânea e mucormicose disseminada. No que concerne a odontologia e a cirurgia maxillofacial, os casos que apresentam extensão de mucormicose para cavidade oral tem sido menos reportados e assim requerem mais estudos. Os pacientes que compareceram a nossa clínica apresentavam aumento de volume endurecido, drenagem de fluidos dos seios maxilares e mobilidade dentária. Clinicamente tanto a osteomielite quanto a mucormicose apresentaram-se de forma semelhante. Assim, análise histopatológica foi utilizada para estabelecimento do diagnóstico definitivo. Conclusão: A mucormicose é uma patologia grave que requer intervenção precoce para estabelecimento do tratamento. A ulceração e necrose características usualmente estão ausentes nos estágios iniciais da lesão, assim análise histopatológica e radiográfica são necessárias para o diagnóstico final. Intervenção precoce é necessária para diminuir a morbidade. O tratamento envolve o debridamento cirúrgico da área necrosada seguida de terapia antifúngica sistêmica. Recentemente, houve um aumento nos casos de mucormicose, após a Segunda onda da pandemia de COVID-19 na índia. Os casos acometiam principalmente pacientes imunocomprometidos, com diabetes mellitus, doenças hematológicas malignas e em uso de corticosteróides. A mucormicose invadindo o palato pelos seios maxilares foi raramente descrita. Na era pós-COVID a mucormicose envolvendo a cavidade oral deve entrar no painel de diagnósticos diferenciais para que o tratamento adequado possa ser instituído precocemente.(AU)
Subject(s)
Humans , Female , Adult , Immunomodulation , Mucormycosis , NecrosisABSTRACT
The idiopathic form of sclerosing encapsulating peritonitis, also known as abdominal cocoon, is a rare entity of unknown cause that leads to intestinal obstruction due to complete or partial encapsulation of the small intestine by a fibro- collagenous membrane. As the initial clinical features are non-specific, they often remain unrecognized making it difficult to make a definite pre-operative diagnosis. Recurrent episodes of small intestinal obstruction along with relevant imaging findings and lack of other causative mechanisms, gives rise to a clinical suspicion. We report a young lady who presented to us with features suggestive of acute intestinal obstruction. Thorough enquiry revealed similar episodes on multiple occasions in the past which was temporarily relieved with conservative management. The need to keep an open mind regarding the uncommon causes of commonly encountered problems is the point of interest in our case.
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Using the immune system to its advantage, Salmonella Typhi initially invades the gut followed by the reticuloendothelial system and finally the nervous system, involvement of which usually occurs around the second week of fever. In developing countries, delayed diagnosis is predominantly due to hesitation in seeking treatment. Our subject presented with fever since one week, altered mentation, headache and neck pain; she was diagnosed with enteric fever. Although her neurological abnormality could be a complication of the infection, it appeared when she became afebrile- hence we evaluated her for autoimmune conditions. Positive results hinted at autoimmune encephalitis triggered by the infection; further studies were inconclusive. Association of enteric fever with autoimmune encephalitis has not been reported. Three months later, presence of antinuclear antibodies (ANA) was rechecked- a negative report led to a retrospective diagnosis of transient ANA positivity in a nonautoimmune inflammatory disease, the case in point being enteric fever.
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Background and Objectives@#Cochlear implantation in late implanted prelinguals necessitates a complex decision-making process for clinicians and patients due to the uncertainty of achieving adequate benefit in auditory and speech perception. This study longitudinally evaluated clinical and social outcomes of prelingually deaf children with implantation in their late childhood. @*Subjects and Methods@#A total of 113 (49 females and 64 males) participants, with an age range of 5-15 years, were assessed for the pre-implant parameters such as hearing loss etiology, aided responses, anatomical aspects, and psychological evaluation. The Category of Auditory Performance, Speech Awareness Threshold, Speech Reception Threshold, and Speech Discrimination Score were administered to assess the patient’s auditory skills. Further, the Speech Intelligibility Rating scale was administered to evaluate the patient’s speech intelligibility at 3, 6, 9, 12, 18, and 24 months post-surgery. Subjectively perceived benefits were evaluated using the satisfaction rating scale and a questionnaire. @*Results@#The statistical results showed a significant impact of cochlear implantation in all domains. Positive impact and improvement post-implantation were noted in all the spheres, including auditory, linguistic, social, and educational. @*Conclusions@#The study highlighted that the outcomes of a cochlear implant at a later age might not parallel with the implantation at a younger age. However, this still provides measurable benefits even after a longer period of auditory deprivation.
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There are several controversies regarding the role of sex and gender in the pathophysiology and management of acute stroke. Assessing the role of sex, i.e., biological/pathophysiological factors, and gender, i.e., sociocultural factors, in isolation is often not possible since they are closely intertwined with each other. To complicate matters even more, the functional baseline status of women and men at the time of their first stroke is substantially different, whereby women have, on average, a poorer reported/ascertained baseline function compared to men. These differences in baseline variables account for a large part of the differences in post-stroke outcomes between women and men. Adjusting for these baseline differences is difficult, and in many cases, residual confounding cannot be excluded. Despite these obstacles, a better understanding of how patient sex and gender differences influence acute stroke and stroke care pathways is crucial to avoid biases and allow us to provide the best possible care for all acute stroke patients. Disregarding patient sex and gender on one hand and ignoring potential confounding factors in sex- and gender-stratified analyses on the other hand, may cause researchers to come to erroneous conclusions and physicians to provide suboptimal care. This review outlines sex- and gender-related factors in key aspects of acute stroke, including acute stroke epidemiology, diagnosis, access to care, treatment outcomes, and post-acute care. We also attempt to outline knowledge gaps, which deserve to be studied in further detail, and practical implications for physicians treating acute stroke patients in their daily practice.
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Introduction: Bipolar affective disorder (BPAD) is a chronic psychiatric disorder with an admixture of frequent and recurrent episodes of mania, hypomania, depression, or mixed episodes. More than 1% of the world's population and at least 0.3% of the Indian population are affected by BPAD. We have chosen a case of BPAD with multiple episodes to study the impact of psychosocial intervention in the management of the illness of the affected person and family. The index client, a male, Presentation of the case: 32 years of age, visited the Institute of Psychiatry (IOP) with caregivers and was referred to the psychiatric social work department of the IOP on April 24, 2019, with symptoms of mania and psychosis. He had 7-years history of psychiatric illness, including multiple episodes of mania and depression, as well as frequent irregular medication; burden and conflict, insufficient social support, poor communication and interaction patterns, poor coping and problem-solving skills in the family. Therapists imparted Interpersonal and Social Rhythm Therapy (IPSRT) and family-focused therapy to the client and family members. It was found that there Discussion: was a significant difference between pre- and postpsychosocial interventions in the life and wellbeing of a person with BPAD and his family. Post intervention, client's level of social and occupational functioning was increased, high expressed emotion had been notably decreased, adaptive patterns had been improved, and cohesion in the family had been strengthened. The client and his family members learned to prevent development of future episodes. Conclusion: Psychiatric social work interventions have been a key area in the management of BPAD involving the family, which helps in maintaining a prolonged euthymic period and better treatment compliance.
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There has been a striking increase in the geriatric population worldwide over the last few decades. As the aging process continues to alter functioning of all body systems, the human voice is also significantly affected. The senile voice is characterized by its changes in pitch, hoarseness, tremulousness, and breathiness with reduced harmonics and intensity. Such phonatory changes in the elderly may hinder effective communication, thus bringing down their confidence levels and impairing their quality of life. These characteristic features that distinguish the senile voice from younger speakers are accompanied by age?related changes in the organ of phonation, the larynx. The summative morphological and structural changes occurring in the elderly larynx have been referred to as “Presbylarynx.” The present review article is an attempt by the authors to explore the various anatomical age-related changes occurring in the larynx that may be responsible for altered vocal function in the elderly. An improved understanding of the anatomical basis of the aged voice can give further directions into the management of vocal disorders and improved speech performance in the elderly.
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Introduction : Depression is the leading cause of disease-related disability among women in the world today. Depression is a serious condition that can impact every area of women’s life. It affects social life, family relationships, career, and one’s sense of selfworth and purpose. To determine the prevalence andObjective: associated risk factors of depression among rural housewives aged 18–59 years. A community basedMethod: cross sectional study was carried out among 414 housewives in rural field practice area of Department of Community Medicine, Jhalawar Medical College, Jhalawar, Rajasthan. Participants were selected by simple random sampling technique. A pre designed semi structured proforma was used for collecting information on socio-demographic characteristics, medical history, family problems, personal history and obstetrical and gynecological history. Assessment of depression was done by using self-reported instrument Patient Health Questionnaire-9 (PHQ-9) Out of 414 Housewives, 63 (15.2%) were found to have depression. WithResults: increasing education level, there was a declining trend toward depression. Significantly higher rates of depression were observed among housewives reporting any debilitating ailments in one or more family members (31.2%), some unusual events occurred in family in past (56.2%), presence of any addiction in family members (22.7%) and debt on family (58.8%). Marriage at early age, having first pregnancy at early age, more than two children, menstrual irregularities and suffering from unable to conceive or infertility were the biological factors significantly associated with depression. Prevalence of depression was highConclusion: among housewives in rural community. Many social and biological factors were contributing towards high rate of depression among housewives
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Introduction: The frailty index’s potential as a prognostic marker of sepsis is so far been untapped. Here we studied the predictive value of frailty index in the elderly with sepsis. Methods: This prospective cohort study was conducted in a tertiary level hospital in North India. The duration of the study was 18 months starting from January 2020 to July 2021. The frailty index was calculated along with traditional markers of sepsis such as sequential organ failure assessment (SOFA), quick sequential organ failure assessment (qSOFA), and systemic inflammatory response syndrome (SIRS) within 24 hours of admission in elderly patients suspected to have sepsis. The area under the receiver operating characteristic (AUROC) of frailty index, SOFA, qSOFA, and SIRS was compared for in-hospital and 3-month mortality. Results: There was no significant difference between the performance of the frailty index and SOFA (DeLong’s test p = 0.242) in predicting in-hospital mortality, but there was a statistical difference between the AUROC of SOFA score (AUC = 0.548) and frailty in predicting 3-month mortality (DeLong’s test p ?0.001). Conclusion: The frailty index had greater sensitivity and negative predictive value among the other scores in predicting in-hospital mortality, whereas SOFA had higher specificity in predicting in-hospital mortality. The frailty index was superior to SOFA and the other prognostic markers of sepsis in predicting 3-month mortality.
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Purpose: Head tilt associated with infantile nystagmus syndrome (INS) can be corrected by (a) operating the oblique muscles, (b) horizontally transposing the vertical rectus muscles, or (c) vertically transposing the horizontal rectus muscles. We report three cases of INS with head tilt corrected by vertically transposing the horizontal rectus muscles in both the eyes. Methods: Three cases of head tilt with INS from an institutional practice operated by a single surgeon were retrospectively reviewed and analyzed. The intervention included full tendon width transposition (upward or downward) of all four horizontal rectus muscles to induce cyclotorsion in the direction of head tilt. The primary outcome measure was the correction of head tilt in the primary position. Results: Three patients (boys) of ages ranging from 4 to 7 years with a pre-operative head tilt of 30° were operated upon. Although one patient’s oblique muscles had been operated on to correct head tilt, another patient had an unmasked face turn after the surgery, which was corrected with a modified Anderson’s procedure. Post-operatively, all patients had a reduction of head tilt to a range of 0–10°. Conclusion: Vertical transposition of horizontal rectus muscles is a simple surgical option to correct head tilt in INS. However, the results may vary based on individual cases
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The most common cause for mortality in burns worldwide is sepsis. American Burn association guidelines 2007 are followed till date. But the confirmation of the sepsis requires tissue/blood culture which takes a minimum of 48-72 hours. Adding Procalcitonin as an adjunct biomarker to the sepsis criteria enhances the predictability of sepsis. This prospective study has been carried first time with the help of Procalcitonin. The prospective study was performed between October 2019 to October 2021 in the department of burns and plastic surgery wherein we evaluated serum procalcitonin of 52 patients with (30 %to 60%) Total Body Surface Area burns within 24 hour of admission and at the time of burn sepsis suspicion as per American burn Association2007 guidelines .The Positive blood/tissue culture was taken as the confirmatory evidence of sepsis. Patients were divided in two groups, sepsis (Group A) and non sepsis (Group B). All the parameters for sepsis as per ABA guidelines were serially noted . The Sensitivity and specificity of the test was 89.29 % and 58.33 % respectively. 2.1 ng/ml was taken as the cut off value for diagnosing sepsis in burn patient with an area under the curve of 0.78 at 95% confidence interval. Elevated Procalcitonin concentrations correspond to the documented sepsis in 30 -60 % of burns which enhances the Predictability of diagnosing burn sepsis .Hence we recommend to add procalcitonin as an adjunct biomarker to diagnose sepsis in burn patients.
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Ectodermal dysplasia (ED) is a congenital disorder exhibiting multiple disorders that affect ectodermal tissues. Over 150 different presentations of the syndrome have been reported, of which the most commonly encountered are hidrotic and hypohidrotic variants. In the present paper, we report the case of an 8-year-old male who was diagnosed with hypohidrotic ED by a physician. The extraoral and intraoral findings were recorded and found in accordance with the diagnosed variant. A comprehensive therapy was initiated which included child and parent counseling, familiarizing the child with dental setup, and delivery of a removable partial denture for the upper arch and a removable complete denture for the lower arch. The importance of follow-up and newer dentures as per the growth of the patient was also explained to the parents. The article highlights the key role of a pediatric dentist in managing the child and parents in syndromes as such
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Background: The management of septic shock has undergone significant modifications in the past decade. Various studies have concluded that while corticosteroids reduce the duration of shock, they do not have any proven mortality benefit. Moreover, the time of initiation of corticosteroids has been debatable. Since, little literature is available on geriatric patients, we have designed a randomized trial to assess the importance of early initiation of low dose hydrocortisone comparing with the standard therapy. Objectives: To determine the efficacy of early initiation of low dose hydrocortisone in reducing mortality in septic shock in geriatric patients. Methods: We conducted a single blinded, randomized controlled trial at a tertiary care hospital in India. Geriatric patients (age>60 years) fulfilling the criteria for septic shock were included in the study. All the participants were randomly assigned to two arms- intervention and standard therapy group. The outcomes were studied in terms of 28-day mortality, duration of ICU stay, duration of vasopressor requirement and need for mechanical ventilation Results: Total 120 patients were randomized to either Intervention arm (N=61) or the Standard therapy arm (N=59). The number of patients with reversal of shock was higher in the intervention arm (53.4%) but no statistically significant association (p= 0.575) was found. There was no significant difference between the two groups in terms of 28- day mortality, length of ICU stay, need for mechanical ventilation and duration of vasopressor support. Conclusion: This single centre trial demonstrated that there was no survival benefit associated with the early initiation of low dose hydrocortisone treatment in patients with vasopressor-dependent septic shock. It raised the concern that whether steroids are safe in elderly patients with septic shock.
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Although rare, a metastatic renal cell carcinoma could present with 68Ga-DOTATATE avidity. A 66-year-old man with von Hippel-Lindau syndrome (VHL) presented with 68Ga-DOTATATE uptake in the pancreatic head, splenic hilar region, and multiple osseous sites, including the right lateral portion of the T9 vertebrae. Biopsy of the T9 lesion confirmed metastatic renal cell carcinoma. Various VHL-associated cancers may display 68Ga-DOTATATE avidity, which can change and guide clinical decisions for the patient.
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Randomized controlled trials (RCT) are the basis for evidence-based acute stroke care. For an RCT to change practice, its results have to be statistically significant and clinically meaningful. While methods to assess statistical significance are standardized and widely agreed upon, there is no clear consensus on how to assess clinical significance. Researchers often refer to the minimal clinically important difference (MCID) when describing the smallest change in outcomes that is considered meaningful to patients and leads to a change in patient management. It is widely accepted that a treatment should only be adopted when its effect on outcome is equal to or larger than the MCID. There are however situations in which it is reasonable to decide against adopting a treatment, even when its beneficial effect matches or exceeds the MCID, for example when it is resource- intensive and associated with high costs. Furthermore, while the MCID represents an important concept in this regard, defining it for an individual trial is difficult as it is highly context specific. In the following, we use hypothetical stroke trial examples to review the challenges related to MCID, sample size and pragmatic considerations that researchers face in acute stroke trials, and propose a framework for designing meaningful stroke trials that have the potential to change clinical practice.
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Background: Sarcina ventriculi, a gram-positive coccus, are occasionally found in gastric biopsies. Although Sarcina had been described more than 150 years ago, little is known about its pathogenicity in humans. Method: This retrospective case series included patients who were identified with Sarcina infection. We report clinicopathologic characteristics of 13 patients with Sarcina in gastric or duodenal biopsies. Result: The presenting symptoms included: epigastric discomfort (n=6), epigastric pain (n=4), anorexia (n=6), nausea and vomiting (n=5), constipation (n=2), diarrhoea (n=2) and weight loss (n=3).All patients had evidence of mucosal injury.Sarcina was found on mucosal surface.12 patients had food residue on oesophagogastroduodenoscopy (OGD). 10 patients had gastric outlet obstruction (GOO), antral narrowing in 7 and duodenal obstruction in 3. 6 patients had malignant GOO. Causes of benign GOO included Helicobacter Pylorigastritis (n=1), eosinophilic gastritis (n=1) and duodenal ulcers (n=2, 1 NSAIDs). Of the 5 patients that had follow-up OGD, 2 had gastric residue. One patient had recurrence of symptoms with the persistence of sarcina on biopsy at 3 months. Symptoms improved at 6 months and no evidence of sarcina on biopsy at 6 months. Conclusion: Our findings suggest GOOcan be considered as a predisposing factor for Sarcina infection. Sarcina infection may not be the aetiology for GOObut may complicate recovery and may lead to life-threatening complications. Clinicians and pathologists must be aware of such microorganisms and must be documented in the histology report for further investigation and therapeutic consideration.
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BACKGROUND Individuals working in the information technology (IT) industry are likely to develop lifestyle disorders. We aimed to determine the presence of defaecation-related disorders in IT personnel in Chennai. METHODS This cross-sectional, questionnaire-based study was done from June to December 2018. We included employees between 18 and 60 years of age and excluded those with <1 year stay in Chennai, pregnancy and those who sent incomplete responses. The cohort was classified as normal, irritable bowel syndrome (IBS), faecal evacuation disorder (FED) and a combination of the latter two. RESULTS The overall response rate was 95.6%. The study included 54.7% of men, and the median age was 31 years. The majority of respondents used an Indian toilet (554; 58%). Almost all (96.2%) passed stools daily, and stool consistency was soft in 59%. Based on the study criteria, 180 (18.8%) had FED, 56 (5.9%) had IBS and a small group had a combination of symptoms of IBS and FED (20; 2.1%). Respondents with symptoms of IBS had a higher proportion of comorbid states (p<0.0001), lesser stool frequency (p<0.0001) and required more toilet time (p<0.00001). CONCLUSION Over one-fourth (26.7%) of the respondents had defaecation-related issues, 18.8% had symptoms suggestive of FED and 5.6% that of IBS, often above 30 years of age.