Gracin's Syndrome, a Rare Clinical Challenge in the Setting of Invasive Mucormycosis: A Systematic Review.

Garcin's Syndrome is a rare pathology involving multiple cranial nerves in the setting of invasive mucormycosis, usually in immunocompromised patients. Owing to its extremely high mortality rate, clinician should have a high suspicion for diagnosis. This article presents a rare case of Rhino-Orbito-Cerebral Mucormycosis with Garcin's syndrome in a 33-years old male along with a discussion of previously reported cases. The case is discussed in light of scant contemporary literature on the cited subject. A thorough search using the keywords Garcin's Syndrome, Invasive Mucormycosis, Rhino-orbital, Rhino-cerebral mucormycosis, was conducted on Pubmed/MEDLINE, Google scholar, LILACS, medRxiv and Google. A total of six reported cases found in international literature published between 2000 and 2020 were reviewed and analyzed. Garcin's Syndrome is associated with a high mortality rate. In our review, of the total seven patients, only three survived, bringing the collective mortality to 42.85%. Patients had multiple cranial nerve involvement leading to long term sequelae. Our case showed the unique finding of VIII nerve involvement. Early intervention helped in patient survival and better functional outcome. This literature review highlights the distinct clinical nature of the presentation of disease and the importance of prompt diagnosis and early management in the reversal of complications in an otherwise potentially fatal disease.

Psychiatric Morbidity in Infertility Patients in a Tertiary Care Setup.

CONTEXT: Infertility is regarded as a trigger for psychological morbidity. Infertile couples often suffer from anxiety, depression and lack of self confidence. AIMS: To study the demographic factors associated with infertility in a tertiary care setup and to determine the level of anxiety and depression associated with it by using standardized scales. The study protocol also included studying the various coping strategies employed by these patient groups. SETTINGS AND DESIGN: Case control study. MATERIALS AND METHODS: A prestructured questionnaire based study conducted for a span of 6 months. The study population included the patients attending the infertility and the family planning outpatient department. We applied the Hospital Anxiety and Depression scale (HADS) and the Becks Depression Inventory (BDI). Brief COPE Inventory was applied to look for the various coping measures that are employed by the anxious and depressed patients. STATISTICAL ANALYSIS: Data analysis was done using SPSS ver20. RESULTS: A total of 280 study subjects were included in the study; which included 140 women from the infertility clinic and 140 from the family planning OPD. A total of 56.4% (79/140) of the females were found to be suffering from depression and 68.9% (96/140) of the females were found to be suffering from anxiety and depression both. Seven risk factors were found to be significant for depression based on the Beck Depression Inventory (BDI) scale and 6 risk factors were found to be significant based on the Hospital Anxiety and Depression Scale (HADS). The most common coping method employed by depressed women was venting 72.2% (57/79) followed by behavioural disengagement 70.9% (56/79); whereas the most important coping method employed by the anxious and depressed women was behavioural disengagement 71.9% (69/96). CONCLUSION: Anxiety and depression is common among patients suffering from infertility and measures should be taken to alleviate it.

Congential lumbar hernia with malrotation of left kidney and hydronephrosis in an infant: a rare presentation.

Congenital Lumbar hernia was previously known as Lumbocostovertebral syndrome. This syndrome consists of the presence of hemivertebrae, rib defects, abdominal wall anomalies and hypoplasia of the abdominal musculature. This case report describes a 40-hour-old infant with malrotation of left kidney and hydronephrosis in association with congenital lumbar hernia. Various congenital renal anomalies like renal pyelectasis, bilateral renal agenesis and pelviureteric junction obstruction, malascended kidneys, hypospadiasis have been reported in association with this disease. Malrotation has only been reported in adults so far. However ours is the first ever case in literature to report malrotation of kidney in association with this syndrome in neonatal age group. Treatment of this condition is done usually by mesh hernioplasty. Presence of this condition must prompt the surgeon to carry out all possible investigations to rule out various other congenital orthopedic, neurological, and urological anomalies.

High blood pressure in dialysis patients: cause, pathophysiology, influence on morbidity, mortality and management.

Dialysis is initiated in a patient with End stage renal disease. The recent guidelines suggest the initiation of dialysis when symptoms and signs of kidney failure are present and not merely a decrease in GFR. The most common complication postdialysis is the occurrence of hypotension. However many dialysis patients are found to be hypertensive. In this article, we mention the cause and pathophysiology of hypertension in dialysis patients and its management.