Institutional experience of mucormycosis over a period of 10 years - retrospective case series.

Mucormycosis is an invasive fungal infection seen in immunocompromised patients. Most common presentation is face or orbital pain, headache, lethargy, visual loss, proptosis, or palatal ulcer. Because of its angioinvasive properties, it can rapidly spread to intracranial tissues and orbit. It can lead to fatal complications such as blindness, intracranial infections, convulsions and even death. Aim of current study was to diagnose this condition; a high index of suspicion is required. Blackish crusts are characteristically seen and Potassium hydroxide (KOH) staining of these crusts can give a rapid diagnosis. Methods: Study Design was retrospective review of the charts. We reviewed the charts between January 2001 and December 2010 and compiled together 60 cases of mucormycosis. Results: The most common presentation was orbital cellulitis. Some patients presented with features of acute sinusitis. The most common cause of immunosuppression was diabetes mellitus. Patients were started on amphotericin. The prognosis was bad in 7 patients who lost vision and 8 patients died. Conclusion: Diagnosis in the early stage needs a high degree of suspicion. The underlying illness, the time between the onset of the disease and the establishment of treatment, and the occurrence of cerebral ischemic events play a role in worse survival rates.

Breath carbon monoxide levels in different forms of smoking.

Background and Objectives. Bidi, cigarette, hookah and chillum are common modes of tobacco smoking in India. Many people consider hookah and chillum smoking less toxic because smoke is filtered through water or wet cloth. We evaluated the toxicity of tobacco smoking by measuring end-tidal carbon monoxide (eCO) levels after various modes of smoking. Methods. Eighteen healthy smokers who smoked bidi, cigarette, hookah and chillum on six days were studied. They smoked one bidi, one cigarette, five minutes hookah, one serve (15 minutes) hookah, five minutes chillum and one serve (15 minutes) chillum on six days randomly. The eCO values were measured before initiation of smoking and for a period of one hour after the smoking session. Increase in eCO values in comparison to baseline after different modes of smoking was compared. Results. In comparison to baseline, mean eCO levels were raised by 4.94 (0.96) parts per million (ppm) immediately and 4.17 (1.07) ppm 60 minutes after cigarette smoking. Bidi smoking caused slightly less increase in mean eCO levels (3.17 [0.82]). One serve of hookah and chillum smoking caused elevation of mean eCO values by almost eight-folds higher than that of cigarette smoking. Five minutes of smoking with hookah (22.18 [5.29]) and one serve of hookah (33.0 [8.76]) and chillum (40.14 [12.73]) caused significantly higher values of mean increase in eCO in comparison to cigarette smoking (p<0.001). Conclusion. With regard to eCO levels, hookah and chillum smoking are much more toxic than cigarette smoking.