Mucormycosis in immunocompetent individuals: an increasing trend

OBJECTIVE: Mucormycosis is a fatal infection of the immunocompromised individual. It is unusual to affect healthy individuals. We report eight such cases of infection caused by this emerging fungal pathogen in healthy patients. Of the eight cases, three were infected with Apophysomyces elegans, again an unusual pathogen causing mucormycosis. STUDY DESIGN: Retrospective case review conducted at a tertiary referral center. METHODS: From 1999 to 2003, eight cases of mucormycosis were managed in otherwise healthy patients. Seven of them were treated with surgery. Clinical presentation, imaging studies, mycologic findings, operative findings at surgery, and postoperative results were evaluated. A review of the literature pertaining to mucormycosis infecting otherwise healthy patients and A. elegans infecting otherwise healthy patients in the nose and paranasal sinuses also was done. RESULTS: Of the eight cases, three were infected with A. elegans, with no history of trauma or any invasive procedure. Seven patients underwent surgical treatment. Histopathologic examination showed broad, sparsely aseptate, thin-walled hyphae and angioinvasion with thrombosis. CONCLUSION: Mucormycosis must be considered in the differential diagnosis of any severe acute headache, sinusitis, or orbital cellulites, not only in immunocompromised patients but also in the absence of any underlying disease. Successful treatment requires tissue débridement and injection of amphotericin B.     

Electro-clinical characteristics and postoperative outcome of medically refractory tumoral temporal lobe epilepsy

BACKGROUND: Very few studies have specifically addressed surgical treatment and outcome of patients with tumor-related temporal lobe epilepsy (TLE). AIM: To define the postoperative seizure outcome and the factors that influenced the outcome of patients with tumor-related TLE. MATERIALS AND METHODS: We selected patients whose surgical pathology revealed a temporal lobe neoplasm and who had completed > 1 year of postoperative follow-up. We reviewed the clinical, EEG, radiological and pathological data, and the seizure outcome of these patients and assessed the factors that influenced the outcome. RESULTS: Out of the 409 patients who underwent surgery for refractory TLE during the 8-year study period, there were 34 (8.3%) patients with temporal lobe neoplasms. The median age at surgery was 20 years and the median duration of epilepsy prior to surgery was 9.0 years. MRI revealed tumor in the mesial location in 21 (61.8%) patients. Interictal and ictal epileptiform EEG abnormalities were localized to the side of th lesion in the majority. Mesial temporal lobe structures were included in the resection, if they were involved by the tumor; otherwise, lesionectomy alone was performed. During a median follow-up of 4 years, 27 (79%) patients were completely seizure-free. The only factor that predicted long-term seizure-free outcome was being seizure-free during the first two postoperative years. CONCLUSIONS: Our results emphasize the fact that in patients with tumoral TLE, when the seizures are medically refractory, surgery offers potential for cure of epilepsy in the majority.     

Phrenic nerve palsy in severe tetanus

Unilateral or bilateral raised hemidiaphragms were observed on chest X-ray in three patients with severe tetanus. Diaphragmatic movement was absent on ultrasonography and fluoroscopy. Nerve conduction study confirmed phrenic nerve palsy. Bilateral involvement caused delayed weaning from the ventilator, whereas unilateral involvement was asymptomatic. There was complete recovery from phrenic nerve palsy in all patients.     

Determinants of prescribing meperidine compared to morphine in hospitalized patients

Morphine is a preferred narcotic since meperidine forms toxic metabolites. Determinants of meperidine use have been poorly described. The objective of this study is to explore factors associated with the ordering of meperidine versus morphine. Retrospective chart review of adult patients, randomly selected based on orders for morphine or meperidine. 1552 orders were written for 670 patients. Of these, 36% were for meperidine. In multivariable analysis, the ordering of meperidine was associated with the following variables in decreasing order of importance: physician specialty, total doses received, hospital location, patient race, age and insurance, and physician gender. More orders for meperidine were written for those receiving fewer doses. Though meperidine has little role in the routine management of hospital pain, we found it continues to be used frequently. Importantly, meperidine is ordered more frequently for patients who receive shorter courses of narcotics. Our study suggests that interventions targeted at more appropriate use of meperidine rather than complete elimination might be more acceptable to physicians while minimizing the risk of toxicity.     

Mother-to-child transmission of hepatitis E virus infection

Objectives : Water borne or enterically transmitted non-A-non-B hepatitis is a major public health problem in India. Many of these cases carry fatal outcome. The hepatitis E virus (HEV) has been considered to be the most important causative agent of this entity. The severity and fatality rates of HEV infection are reported to be rather more in pregnant women. However, there is meager information from India, on mother to child transmission of this agent.Methods : During 1997-98, we studied 60 pregnant women suspected to have acute viral hepatitis to understand the frequency of various viral etiologies, disease course and outcome of the pregnancy. Six cord blood samples were tested for IgG, and IgM antibodies against hepatropic viral agents and also for hepatitis E virus RNA by RT-nested PCR using ORF-1 as target.Results : Of the 60 pregnant patients hospitalised at All India Institute of Medical Sciences, New Delhi for acute hepatitis, 22 (37%) were positive for IgM anti-HEV antibodies and 10% were infected with hepatitis B virus. Co-infection of HEV with Hepatitis B and C was seen in 1 and 2 patients, respectively. Most (72%) of the HEV infected patients were in third trimester of pregnancy (P<0.05). Of the 6 cord blood samples tested 3 (50%) were positive for HEV RNA. Though, all mothers were RNA positive, half of the babies did not get infectedin utero with HEV. Fourteen of the 22 (63.6%) HEV infected mothers developed fulminant hepatic failure and all died.Conclusion : The mortality rate in HIV infected mothers was 100%. Mother to child transmission of hepatitis E virus infection was established in 50%     

Evaluation of psychopharmacological effects of petroleum ether extract of Cuscuta reflexa Roxb. stem in mice

The petroleum ether extract of Cuscuta reflexa Roxb. stem (PECR) was evaluated for its psychopharmacological activities in several experimental models using Swiss albino mice. The PECR was found to cause significant reduction in spontaneous activity and exploratory behavioral profiles. It also showed reduction in muscle relaxant activity by rotarod, 30 degrees inclined screen tests and showed significant analgesic properties as well as potentiated remarkably the pentobarbitone sodium, diazepam and meprobamate--induced sleeping time. All these results were compared with respective controls for the evaluation of significance. The presence of steroids in the PECR might he responsible for psychopharmacological activities.     

Fruit extract of Emblica officinalis ameliorates hyperthyroidism and hepatic lipid peroxidation in mice

The ethanolic extract from the fruits of Emblica officinalis Gaertn (Euphorbiaceae) was investigated to evaluate its possible ameliorating effects, on the L-thyroxine (L-T4) induced hyperthyroidism and on hepatic lipid peroxidation in mice. While an increase in serum T3 (triiodothyronine) and T4 (thyroxine) concentrations, and in a thyroid dependent parameter, hepatic glucose 6-phospatase (glu-6-pase) activity was observed in L-T4 (0.5 mg/kg/d) treated animals, simultaneous oral administration of the plant extract at a dose of 250 mg/kg/d (p.o.) for 30 days in hyperthyroid mice reduced T3 and T4 concentrations by 64 and 70% respectively as compared to a standard antithyroid drug, propyl thiouracil (PTU) that decreased the levels of the thyroid hormones by 59 and 40% respectively. The plant extract also maintained nearly normal value of glu-6-pase activity in hyperthyroid mice. The plant extract also decreased hepatic lipid peroxidation (LPO) and increased the superoxide dismutase (SOD) and catalase (CAT) activities in hyperthyroid mice, exhibiting its hepatoprotective nature. Our findings suggest that the test material may potentially ameliorate the hyperthyroidism with an additional hepatoprotective benefit.