Gastrointestinal basidiobolomycosis: Beware of the great masquerade a case report.

Basidiobolomycosis is rare infection caused by the saprophytic fungus Basidiobolus ranarum. Gastrointestinal basidiobolomycosis is an infrequent, albeit, increasingly reported, emerging form of the disease and typically affects immunocompetent individuals with potentially grave sequelae if unrecognized. Acquaintance with this exceptionally rare fungus and its potential for presenting as gastrointestinal mass masquerading as colonic malignancy is critical for timely diagnosis, appropriate treatment and successful clinical outcome. We report a case of gastrointestinal basidiobolomycosis masquerading as colonic malignancy in a 29-year-old Omani patient successfully treated with combination of surgery and prolonged azole antifungal therapy.

Digital sucking induced trophic ulcers caused by nerve deficit from amniotic constriction band.

Two infants presented with amniotic constriction bands (ACB) in the distal third of the forearm. After teeth eruption they developed recurrent skin ulcerations mainly in the distribution of the median nerve from digital sucking. Both patients underwent reconstruction with multiple Z-plasties, followed by neurolysis of the ulnar nerve and sural nerve grafting of the median nerve. This neurological complication presented late in ACB as ulcerative lesions and secondary infection from digital sucking on the insensate digits. Thorough physical examination of the extremities at an early stage in children with ACB is essential to exclude an occult neurological dysfunction. Exploration of peripheral nerves is warranted in cases of deep forearm ACB during their soft tissue reconstruction.

Viability of multiple antibiotic resistant bacteria in distribution lines of treated sewage effluent used for irrigation.

Viability of multiple antibiotic resistant bacteria (MARB) in tertiary treated sewage effluent (TTSE) used for irrigation, was investigated at the Sultan Qaboos University sewage treatment plant (STP). This water recycle system is used here as a model for the systems commonly used throughout Oman and the Gulf region. Samples of TTSE were collected weekly from four sites, 1.5 km from each other. Chlorine levels declined gradually at the three sites with increasing distance from the STP. Viable bacteria, coliforms and nitrate concentrations increased significantly while biological oxygen demand (BOD) declined after STP chlorination. Mean values of turbidity changed slightly. Trace elements values were insignificant. A total of 336 bacteria from 8 genera revealed that the dominant isolates were Enterobacter spp., Pseudomonas spp., and Aeromonas spp. Among the isolates 59.8% were multiply resistant to several antibiotics. Resistance was higher to ampicillin followed by sulphamethoxazole, carbenicillin, streptomycine and minocycline. Frequency of resistance to the 14 antibiotics varied among the isolates. The present system related to the viability of MARB in TTSE used for irrigation may have serious implications for public health and wildlife. Results of this investigation will be of value in modifying current STPs systems and thus avoiding serious health issues.

Coastal sewage discharge and its impact on fish with reference to antibiotic resistant enteric bacteria and enteric pathogens as bio-indicators of pollution.

Presence of antibiotic resistant bacteria as bio-indicators of pollution was monitored in fish (colons and gills) and in sewage treated effluent (STE) in two marine sites in the Gulf of Oman, Muscat. One site was polluted as the sewage effluent STE was directly discharged into the sea while the unpolluted site was 10 km away. A total of 42 water samples (250 mL each) were collected from both sites. In the polluted site, 14 samples were taken directly from the STE discharge point and 14 from the surrounding area near the STE discharging point (7-10 m). Water and fish samples were collected from polluted and unpolluted sites. Chlorine and nitrate levels were significantly higher in STE samples. A significant difference (P<0.005) was found in total bacterial count of fish colon and gills in the two sites. Most probable number (MPN) was significantly higher in STE and polluted seawater over unpolluted. Coliforms were detected in the polluted site only. A total of 320 target enteric normal flora of animals and pathogenic species were isolated from 10 genera taken from water and fish samples. The isolates were exposed to 14 antibiotics. Most of the isolates were resistant to at least one antibiotic with ampicillin was the dominant antibiotic. This is a clear indication that sewage effluent causes contamination of marine wildlife along coastal lines.

Phalangeal osteochondroma: a cause of childhood trigger finger.

Trigger finger is uncommon among children and often caused by various lesions. We report a 5-year old girl who presented with chronic painless triggering of the right ring finger and normal X-ray. She underwent exploration of the finger flexor tendons and release of the A1 pulley. Lack of obvious pathology dictated further wound exploration which revealed a hidden osteochondroma of the proximal phalanx. We believe that adequate surgical wound exposure is necessary if no obvious cause of triggering could be seen in order to rule out an atypical osteochondroma even in the presence of normal X-rays.

Congenital flexion deformity of the middle finger and sagittal band hypoplasia.

PURPOSE: To report a congenital anomaly of the middle finger. METHOD: Nine patients (16 digits) are reported with congenital flexion deformity of the metacarpophalangeal (MCP) joint of the middle finger. Three patients (4 digits) had isolated deformities to the middle finger and in 6 the deformity was part of congenital ulnar drift (CUD) of the hand. Three patients had Freeman-Sheldon syndrome, 2 had nonsyndromic CUD, and 1 had arthrogryposis multiplex congenita. In CUD patients the middle finger had substantially greater flexion deformity of the MCP joint in comparison with other digits. Seven patients were treated surgically and 2 were treated nonsurgically. Five of the surgical patients had bilateral middle finger involvement. RESULTS: During surgery on 12 digits sagittal band hypoplasia of varying degrees was encountered in all patients and in all patients the extensor tendon of the middle finger was underdeveloped and often ulnarly displaced. Longitudinal imbrication of the remnants of the extensor tendon and centralizing the tendon if necessary by radial sagittal band reefing improved MCP joint flexion deformity. CONCLUSIONS: Congenital middle finger-in-palm deformity in our patients was caused by sagittal band and extensor tendon hypoplasia.