RESUMO
Objectives: To determine the epidemiological aspect of mucormycosis, the nature of malignancies complicated by mucormycosis, the initial site of involvement and the subsequent outcome
Methods: This was a cross-sectional study which was performed by reviewing the medical records of 95 patients with leukemia complicated with biopsy-proven mucormycosis admitted to the educational hospitals affiliated with Shiraz University of Medical Sciences over a 21-year period. We recorded demographic information including age and sex and disease characteristics such as type of leukemia, site of involvement, paraclinical findings at the time of admission and the outcome of the patients. The incidence of mucormycosis in leukemia was determined by identifying the number of leukemia patients diagnosed within the last 17 years
Results: The male to female ratio was 2.39:1 in of 95 patients studied. The overall incidence rate of mucormycosis was 4.27 per 100 leukemic patients in last 17 years which showed a decreasing trend from 2001 to 2011. The most frequent type of leukemia was acute myelogenous leukemia [AML] which was found in 58 patients [61.5%]. The most common site of initial tumor involvement was sinonasal [90.16%]. The mortality rate was about 54%, compared to the mortality rate of about 43.24% in patients with best prognosis of AML
Conclusion: The incidence of mucormycosis in leukemia showed a decreasing trend in our country and its recent incidence is comparable to that of other regions. The best preventive method against this lethal infection is to modify and control the environment which reduces the risk of exposure to air-born fungal spores
RESUMO
Objectives: To determine the prevalence and predisposing factors of mucormycosis in patients with diabetes mellitus [DM] in a Shiraz referral centers
Methods: This retrospective case control study, reviewed the medical records of 162 patients with pathologically confirmed diagnosis of mucormycosis hospitalized in two major Shiraz University hospitals during the last 21 years. For each diabetic patient, two patients with diabetic ketoacidosis [DKA] matched for age, sex and the date of admission was selected as control group. Age, type of diabetes mellitus [DM] and duration of involvement as well as paraclinical findings were compared between cases and controls
Results: There were 162 patients with murormycosis of which 30 [18.5%] had DM as predisposing factor
Diabetes was the second common predisposing disease next to leukemia. There were 19 [63.3%] women and 11 [36.7%] men among the patients. The overall mortality rate was 53.33% mortality rate. The mean age of the patients was 45.3 +/- 17.6 years. The mean duration of diabetes in case and control groups were 5.75 +/- 5.43 and 7.2 +/- 7.85 years respectively, without any statistical significance between them [p=0.063]. Blood sugar in patients was lower than control group [p=0.012]. Serum bicarbonate level in case group was higher than in control group [p<0.001]. Arterial pH in control group was more acidic than case group [p<0.001]. Insulin; dependent DM was significantly more prevalent in control group compared to case group [73.4% vs. 36.6%; p=0.002]
Conclusion: Our study showed that the number of hospitalized patients with mucormycosis over the last 7 years has been decreased which is due to better control of infection in diabetics. In addition to hyperglycemia and acidosis, several other unknown factors like immune defects may predispose diabetics to this fungal infection
RESUMO
The relation between serum osmolality, glucose, sodium, bicarbonate, arterial pH, BUN and level of consciousness was studied in 189 patients with diabetic ketoacidosis [DKA]. There was much overlap between all laboratory values among various groups, even when there was a statistically significant difference. To find a better predictor, we defined a new factor as serum osmolality/arterial pH. This factor was significantly higher in drowsy and stuporous compared with alert and drowsy patients [p=0.007 and p= 0.03 respectively], but not different between stuporous and comatose patients [p= 0.46]. Again much overlap could be seen between groups. There was at least one other problem, either as a coexisting or a precipitating factor, in 18 [23.3%] of the alert, 24 [29.2%] of the drowsy, 11 [43.4%] of the stuporous and 4 [57.1%] of the comatose group. We conclude that none of these clinico-biochemical parameters can be a reliable predictor of the level of consciousness in patients with DKA, and consideration and exclusion of other conditions associated with altered consciousness that may occur in diabetics should be routine