Rhino-orbito-cerebral mucormycosis: patient characteristics in pre-COVID-19 and COVID-19 period.

BACKGROUND: Rhino-orbito-cerebral-mucormycosis (ROCM), a rare and potentially fatal disease was seen in increasing numbers during the COVID-19 pandemic. This study describes and compares the patient characteristics and outcomes in COVID-19 associated mucormycosis (CAM) and non-COVID-19 mucormycosis (non-CAM). METHODOLOGY: CAM patients (24 cases) were recruited from the COVID-19 period and non-CAM (24 controls) from the pre-COVID-19 period. Clinical data of the CAM group was collected retrospectively with 3 month outcomes prospectively. The non-CAM group data was collected retrospectively. Patient characteristics were compared and risk factors for mortality in ROCM were assessed. RESULTS: Orbital symptoms [altered vision, restricted eye movements, ptosis] and intracranial involvement were higher in CAM patients on presentation. Similarly, the radiological involvement of orbit (orbital apex, superior orbital fissure) and intracranial cavity (intracranial thrombosis, cavernous sinus) was also higher in CAM patients. Newly detected diabetes was found only in CAM patients (29.2%). Although univariate analysis suggested an increased mortality risk in ROCM patients with orbital involvement, the multivariate analysis showed no increased risk with any of the parameters assessed, including COVID-19 positivity. CONCLUSIONS: Compared to the non-CAM, the disease presentation was severe in CAM with higher frequency of orbital and intracranial involvement. However, with early detection and treatment, the short term survival was comparable in both groups.

Unusual complications of bone wax at the skull base.

OBJECTIVE: This study aimed to describe the clinical presentation, microbiological profile and management of complications of bone wax usage for surgical procedures at the skull base. METHOD: The case records of a series of five patients who developed post-operative surgical site complications because of bone wax usage during skull base surgery were reviewed. RESULTS: In all five patients, persistent site-specific clinical features were noted along with intra-operative presence of excessive bone wax. Three unique cases of presentation, one with a fungal brain abscess because of Aspergillus flavus infection, another with fungal osteomyelitis because of Trichosporon beigelii infection and a third with intradural migration of bone wax into the cerebellopontine angle cistern are highlighted. CONCLUSION: The presentation of surgical site infection at the skull base because of excessive use of bone wax can be manifold. The need for testing appropriate cultures including fungal culture is highlighted.

Urodynamic Changes in Pelvic Organ Prolapse and the Role of Surgery.

BACKGROUND: Pelvic organ prolapse (POP) is a major health problem of the "elderly" lady. The urological changes associated with POP and the beneficial effects of surgery on these changes continues to be controversial. We studied the urodynamic changes in POP and the effect of definitive surgery on these changes. METHODS: A total of 50 cases of POP, over a two year period, were subjected to urodynamic studies both pre and postoperatively and the data analyzed, to ascertain the effect of surgery on the urological profile of a patient with POP. RESULT: Four of the 50 patients studied had demonstrable stress urinary incontinence and two of these benefited significantly after surgery. In addition it was observed that four new patients developed stress urinary incontinence (SUI) postoperatively. It was also observed that the values of Qmax significantly improved after surgery from 9.2ml/s to 18.6ml/s. CONCLUSION: Definitive surgery improves the urological profile of the patient with POP, to a certain extent. A good clinical examination of patients with POP from the urological viewpoint, is essential preoperatively, to pick up the patients who are likely to develop stress incontinence postoperatively, so that corrective action can be initiated during surgery.

Common emergencies in cancer medicine: infectious and treatment-related syndromes, Part II.

This article completes a summary of the common medical emergencies that can occur as a result of infectious processes (Part I) and antitumor treatment secondary to chemotherapy, biological response modifiers, or radiotherapy (Part II). The use of high-dose cytotoxic agents, coupled with the common instillation of indwelling central venous access devices, have altered the spectrum of infectious etiologies that are appreciated in clinical practice. In addition, a myriad of cytotoxic agents and radiotherapeutic treatment schemes are used widely in clinical oncologic practice. While most of their related side effects are not considered life-threatening emergencies, they can be fatal if not recognized early and treated promptly. Moreover, some of these infectious and treatment-related sequelae can be prevented. This article highlights some of these clinical observations.

Common emergencies in cancer medicine: infectious and treatment-related syndromes, Part I.

This two-part article, the last in a series of articles on cancer emergencies, summarizes the common medical emergencies that can occur as a result of infectious processes (Part I) and antitumor treatment secondary to chemotherapy, biological response modifiers, or radiotherapy (Part II). The use of high-dose cytotoxic agents, coupled with the common instillation of indwelling central venous access devices, have altered the spectrum of infectious etiologies that are appreciated in clinical practice. In addition, a myriad of cytotoxic agents and radiotherapeutic treatment schemes are used widely in clinical oncologic practice. While most of their related side effects are not considered life-threatening emergencies, they can be fatal if not recognized early and treated promptly. Moreover, some of these infectious and treatment-related sequelae can be prevented.

Inflammatory demyelinating polyneuropathy in a haemophiliac associated with human immunodeficiency virus infection, responding to high dose intravenous immunoglobulin.

We describe what we believe to be the first case of chronic inflammatory demyelinating polyneuropathy (CIDP) occurring in a haemophiliac infected with the human immunodeficiency virus (HIV), and the first patient to show a clinical response to treatment with high dose i.v. immunoglobulin. A 55 year old, severe haemophiliac, known to be positive for HIV antibody, presented with a short history of motor weakness and variable sensory loss in both lower limbs. Clinical examination, electrophysiology and sural nerve biopsy confirmed a diagnosis of CIDP. He was treated with a 4-day course of high dose i.v. immunoglobulin, given as a daily infusion. This resulted in dramatic improvement in his neurological status which was evident both clinically and functionally. We conclude that CIDP can occur in HIV-positive haemophiliacs as it does in homosexuals and drug abusers infected with the virus. We also suggest that high dose i.v. immunoglobulin may be effective in the treatment of this condition, especially when practical difficulties preclude the use of plasmapheresis and the use of immunosuppressive drugs is considered hazardous.