Post-COVID-19 rhino-orbito-cerebral mucormycosis-A clinico-mycological study from North India.

The second wave of coronavirus disease 2019 (COVID-19), during the early 2021, lead to a devastating outbreak of mucormycosis in India. This study aimed to determine the aetiology, clinical features, comorbidities, and risk factors of rhino-orbito-cerebral mucormycosis (ROCM) and antifungal susceptibility pattern for the isolates. The study included all suspected cases of ROCM in post-COVID-19 patients attending the hospital from May to December 2021. A total of 70 patients were diagnosed with mucormycosis during the study period. The commonest presentations were rhino-orbital and rhino-orbito-cerebral in 35.7% of cases each. Diabetes mellitus was the commonest associated risk factor in 95.7% of all patients, while 78.5% of the patients were treated with corticosteroids in the recent past, and 25.7% presented with active COVID-19 pneumonia. The commonest isolate was Rhizopus arrhizus n = 14, followed by Aspergillus flavus n = 16, A. fumigatus n = 4, A. niger n = 3, Fusarium oxysporumn = 1, and Apophysomyces variabilisn = 1. Fungal species identification was done by phenotypic methods for all the isolates and DNA sequence analysis of 18 isolates, and antifungal susceptibility testing of 30 isolates was performed by commercially prepared HiMIC plate (HiMedia, Mumbai, India) using broth microdilution for amphotericin B, isavuconazole, itraconazole, voriconazole, and posaconazole. The MIC50 and MIC90 of amphotericin B for R. arrhizus strains were 0.25 and 4 µg/ml, respectively; and the MIC50 and MIC90 results for itraconazole, posaconazole, and isavuconazole were 8 and 8, 2 and 2, and 2 and 8 µg/ml, respectively. In vitro data showed that amphotericin B was the most effective antifungal against most species. The commercially available ready-to-use minimum inhibitory concentration plates are user-friendly for performing antifungal susceptibility, which may be useful in choosing appropriate regimens and monitoring emerging resistance.

Congenital Unilateral Hypoplasia of Kidney with Mesonephric Remnants in the Ureter: A Case Report.

Mesonephric remnants persist as an appendix of epididymis and paradidymis in efferent ductules in males and skene's glands and Gartner's ducts in females. The mesonephric remnant in the renal parenchyma is extremely rare and only a few cases have been reported in the literature. We present a case with a non-functioning atrophic left kidney. Histopathology showed variable-sized ducts filled with colloid-like material surrounded by collagenized stroma. The ureter showed hypertrophied muscle and a few ducts lined by flattened and a few by columnar epithelium resembling epididymis suggestive of mesonephric remnants. IHC for CD10, PAX 8, and GATA3 was positive. A diagnosis of congenital unilateral hypoplasia of kidneys and ureter with mesonephric remnants was given.

Giant cell tumour of the anterior arc of a rib presenting as a breast lump: a case report.

Giant cell tumour (GCT) of the anterior arc of a rib is a very rare occurrence and quite often the diagnosis is delayed. We report a case of GCT of a rib arising from the anterior arc which presented as a breast lump. The diagnosis of GCT was considered in the differentials only when percutaneous biopsy revealed multinucleated osteocleastic giant cells. Further diagnosis was confirmed by spotted oblique radiographs and computed tomography (CT). Surgical excision with repair of the chest wall by a mesh was done. The postoperative histopathological examination of the resected specimen confirmed the preoperative diagnosis of giant cell tumour. The present article aims to aware the reader about such rare presentations of GCT, which should be included in the differential diagnosis of a tumour originating from the anterior arc of the rib.

Use and complications of peripheral vascular catheters: a prospective study.

UNLABELLED: Peripheral vascular catheters (PVCs) are important medical devices but their insertion and usage are associated with discomfort and potential complications such as thrombophlebitis. This article looks into the various aspects of the practice of using PVCs, especially their complications and ways of avoiding them. AIMS: to determine the complications (and their associated factors) related to PVCs. DESIGN: prospective. SETTING: District General Hospital. PATIENTS: a study was undertaken of 86 of the 106 patients consecutively admitted as an emergency over a period of two weeks who had a PVC inserted. METHODS AND INTERVENTIONS: the admitting doctors inserted the PVCs at their discretion. PVC sites were inspected daily. ANALYSIS AND RESULTS: of the 86 PVCs inserted, 42 were never used, while 43 were of large gauge and 29 were left in situ for over 72 hours. Eight patients developed thrombophlebitis, of which four had a large gauge PVC, two were never used and two were left in situ for over 72 hours (P=0.016). CONCLUSIONS: incidence of thrombophlebitis may be reduced by re-siting or removing PVCs within 72 hours. PVC gauge and whether it was used, were not associated with this complication.