Orbital Exenteration in Rhino-Orbito-Cerebral Mucormycosis: A Prospective Analytical Study with Scoring System

Abstract

Mucormycosis is an uncommon, rapidly progressive, angio-invasive, commonly fatal, opportunistic fungal infection. The most critical decision in the management of rhinoorbital mucormycosis is whether the orbit should be exenterated. (1) To layout the indications of orbital exenteration in patients with rhino-orbito-cerebral mucormycosis. (2) To devise a scoring system that predicts the stage at which the exenteration needs to be carried out. A scoring system was devised by a team of experienced Otorhinolaryngologists and Ophthalmologists from prior experience in managing mucormycosis. All patients of mucormycosis visiting our hospital were admitted and included in the study. A total of 15 patients were included. The scoring system is based on 3 main criteria, namely: (1) clinical signs and symptoms. (2) Direct and Indirect Ophthalmoscopy. (3) Imaging. The Sion Hospital Scoring System is an accurate and promising measure to solve the dilemma that is associated with orbital exenteration in orbito-rhino-cerebral mucormycosis.

http://ift.tt/2IjneMW

Post Earthquake Equilibrium Disturbance: A Study After Nepal–India Earthquake 2015

Abstract

Nepal and adjoining areas of India suffered a series of massive earthquakes in April–May 2015. This was followed by a remarkable increase in the patient presenting with vague dizziness like features which could not be attributed to any defined variant of vestibular disorder. Extensive search of literature revealed only scarce information about ambiguous post-earthquake vestibular symptoms and their management. We performed a detailed epidemiological analysis of these patients to analyse the presentation, underlying mechanism and optimal management. The results were scrutinised in light of existing international literature. We observed that earthquake precipitated a psychological stress like event that provoked features of disequilibrium and the neuroanatomical basis of the proposition was explored. We renounce the hypothesis of Secondary BPPV precipitated by earthquake leading to symptoms. The results were interpreted from the perspective of Indian scenario and its utility in post-earthquake disaster management in our country has been highlighted.

http://ift.tt/2paxKx5

Comparison between the efficacy of microneedling combined with 5-fluorouracil vs microneedling with tacrolimus in the treatment of vitiligo

Summary

Background

Several treatment modalities had been used for the treatment of vitiligo, but the optimal treatment has not yet been identified.

Objectives

To study the efficacy of microneedling with 5-flurouracil vs its efficacy with tacrolimus in the treatment of vitiligo.

Patients and methods

Twenty-five patients with vitiligo were subjected to microneedling of 2 patches of vitiligo with dermapen, then application of 5-fluorouracil to 1 patch and tacrolimus on the other patch. This procedure was repeated every 2 weeks for every patient for maximum 6 months (12 sessions). The patients were followed up for 3 months after the last session.

Results

The overall repigmentation was significantly higher in 5-fluorouracil-treated patches compared with tacrolimus. Excellent improvement occurred in 48% of 5- flurouracil-treated patches while only in 16% of tacrolimus-treated patches. In the acral parts, 40% of the patches treated with 5-fluorouracil achieved excellent improvement (repigmentation >75%), while no patch in the acral parts achieved excellent improvement with tacrolimus. However, there was significant difference between the 2 drugs,regarding inflammation, ulceration, and hyperpigmentation which occurred with 5-fluorouracil.

Conclusion

Microneedling combined with 5-fluorouracil or tacrolimus is safe and effective treatment of vitiligo. However, 5-fluorouracil achieved a greater percentage of repigmentation than tacrolimus particularly in the acral parts.

http://ift.tt/2HvJYYR

Orbital Exenteration in Rhino-Orbito-Cerebral Mucormycosis: A Prospective Analytical Study with Scoring System

Abstract

Mucormycosis is an uncommon, rapidly progressive, angio-invasive, commonly fatal, opportunistic fungal infection. The most critical decision in the management of rhinoorbital mucormycosis is whether the orbit should be exenterated. (1) To layout the indications of orbital exenteration in patients with rhino-orbito-cerebral mucormycosis. (2) To devise a scoring system that predicts the stage at which the exenteration needs to be carried out. A scoring system was devised by a team of experienced Otorhinolaryngologists and Ophthalmologists from prior experience in managing mucormycosis. All patients of mucormycosis visiting our hospital were admitted and included in the study. A total of 15 patients were included. The scoring system is based on 3 main criteria, namely: (1) clinical signs and symptoms. (2) Direct and Indirect Ophthalmoscopy. (3) Imaging. The Sion Hospital Scoring System is an accurate and promising measure to solve the dilemma that is associated with orbital exenteration in orbito-rhino-cerebral mucormycosis.

http://ift.tt/2IjneMW

Post Earthquake Equilibrium Disturbance: A Study After Nepal–India Earthquake 2015

Abstract

Nepal and adjoining areas of India suffered a series of massive earthquakes in April–May 2015. This was followed by a remarkable increase in the patient presenting with vague dizziness like features which could not be attributed to any defined variant of vestibular disorder. Extensive search of literature revealed only scarce information about ambiguous post-earthquake vestibular symptoms and their management. We performed a detailed epidemiological analysis of these patients to analyse the presentation, underlying mechanism and optimal management. The results were scrutinised in light of existing international literature. We observed that earthquake precipitated a psychological stress like event that provoked features of disequilibrium and the neuroanatomical basis of the proposition was explored. We renounce the hypothesis of Secondary BPPV precipitated by earthquake leading to symptoms. The results were interpreted from the perspective of Indian scenario and its utility in post-earthquake disaster management in our country has been highlighted.

http://ift.tt/2paxKx5

Cover Image

The cover image, by Matthias Leonhard et al., is based on the Original Article In vitro biofilm growth on modern voice prostheses, DOI: 10.1002/hed.25053.

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Issue Information

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