ABSTRACT
INTRODUCTION: Mucormycosis is a deep mycosis which has been spreading out in recent years. It is still poorly understood and poorly described in sub-Saharan Africa. The authors report a case of sinonasal localization, of fatal evolution and late diagnosis in a young child. OBSERVATION: It is about a 13-year-old child suffering from chronic rhinosinus syndrome for two years. He was observed in stomatology for a necrotic velar ulceration that have occurred for three months. The clinical, radiological and histological explorations were in favor of a sinonasal mucormycosis. The administration of amphotericin B and the surgical treatment did not slow down the fatal evolution. CONCLUSION: Mucormycosis should not be dealt with any diagnostic error and no therapeutic improvisation. It has to be thought about when dealing with a rhinosinusal syndrome with cleft ulceration.
Subject(s)
Mucormycosis/diagnosis , Oral Ulcer/microbiology , Palate, Soft/pathology , Rhinitis/microbiology , Adolescent , Diagnosis, Differential , Humans , Male , Mucormycosis/microbiology , Necrosis/complications , Necrosis/diagnosis , Necrosis/microbiology , Oral Ulcer/diagnosis , Oral Ulcer/pathology , Palate, Soft/microbiology , Rhinitis/complications , Sinusitis/complications , Sinusitis/microbiologyABSTRACT
OBJECTIVES: In Assisted Reproductive Technologies (ART), impaired ovarian reserve represents a therapeutic challenge. The Anti-Mullerian Hormone (AMH) serum level would be a good marker of ovarian reserve and a predictor of response to stimulation. The objective of this study is to assess into a population of infertile couples where the woman has at least one patent tube and where the man has sperm parameters compatible with insemination, whether AMH level less than 12pmol/L can be used to establish a strategy supporting the couple's infertility by comparing their chances of pregnancy after Intra-uterine insemination (IUI) or in vitro fertilization (IVF). MATERIALS AND METHODS: This single-center retrospective study of 1012 patients over 28months compared the pregnancy rates of 2011 ART attempts (1385 IUI and 626 IVF, ICSI excluded) according to the value of serum AMH, either reduced if≤12pmol/L or non-reduced if greater. RESULTS: In IVF, a low AMH reduced pregnancy rate (18.4% vs. 32.9% in the normal AMH group, P<0.0001). Conversely, the AMH value did not influence the success in IUI cycles (14.2% vs. 14.5%, respectively, NS). In cases with low AMH, the pregnancy rate per initiated cycle in IVF (18.4%) was not significantly greater than in IUI cycles (14.2%). Converting an IVF attempt in IUI did not impair the pregnancy rate (13.5% vs. 14.5% after immediate IUI, NS). CONCLUSION: When the serum AMH level is less than 12pmol/L, IUI may be an interesting option in case of IVF failure. However, its place remains to be defined: converting IVF in IUI, IUI in relay of failed IVF, or even as first line therapy when the chances with IVF appear to be minimal.
