Search

Abstract Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18–98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients. The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013.

Competing Interests: There are no conflicts of interest.

In the extra-peritoneal approach for inguinal hernias, pre-peritoneal space creation is one of the most crucial steps. In the absence of well-defined landmarks, it is difficult to identify the correct plane of dissection, and blind dissection can sometimes lead to peritoneal injury, resulting in loss of working space. In this article, we describe our technique of pre-peritoneal space creation by following the fatty tissue of the median umbilical ligament and fatty tissue along the rectus muscle. The data of all patients (total 84) who underwent surgery with this technique between January 2021 and May 2023 were retrieved and assessed for demographics, hernia type, and perioperative complications. Except for two peritoneal injuries, there were no other intraoperative complications., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2024, Gupta et al.)

Objectives: Phaeohyphomycosis refers to infections caused by phaeoid/dematiaceous or darkly pigmented fungi. This study was undertaken to further increase our knowledge about the incidence of phaeohyphomycosis and its causative agents., Materials and Methods: The present study was conducted over a period of one and a half years (January 2018-June 2019) on specimens received from patients with varied clinical manifestations ranging from superficial infections, subcutaneous cysts, pneumonia, brain abscess to a disseminated infection. These specimens were processed in the Department of Microbiology for potassium hydroxide (KOH) examination and culture and in Pathology for cytology/histopathological examination (HPE). All specimens positive on direct examination for dark grey, brown or black fungi were included in the study., Results: A total of 20 specimens were confirmed as phaeohyphomycosis. Most of the patients belonged to the age group of 41 to 50 years. Male: Female ratio was 2.3:1. Trauma was the most common risk factor. Spectra of the isolated fungal pathogens comprised of Bipolaris species, Exophiala species, Curvularia geniculata, Phialemonium species, Daldinia eschscholtzii, Hypoxylon anthochroum, Phaeoacremonium species, Leptosphaerulina australis, Medicopsis romeroi, Lasiodiplodia theobromae, Eutypella species, Chaetomium globosum, Alternaria species, Cladophialophora bantiana and 2 unidentified dematiaceous fungi. Recovery from phaeohyphomycosis was seen in 12 patients, 7 were lost to follow up and one patient succumbed to the illness., Conclusion: Infections caused by phaeoid fungi can no longer be viewed as rare. In fact, phaeohyphomycosis can have myriad of presentations spanning from mild cutaneous infections to fatal brain disease. Therefore, a high index of clinical suspicion is needed to diagnose such infections. The primary treatment modality remains surgical removal of the lesion in cutaneous or subcutaneous infections however disseminated disease with a guarded prognosis requires aggressive management., Competing Interests: None

Introduction: Fine-needle aspiration cytology (FNAC) forms one of the first-line investigations in the evaluation of tumors in modern era. Its role in diagnosing soft tissue tumors (STT) has been well established. However, the morphological overlap and biological heterogeneity of STT pose a morphological diagnostic challenge., Aims: To evaluate the scope of FNAC in diagnosis and categorization of STT and to correlate the cytological features with histological findings wherever available, and to analyze the reasons for discordance, if any., Materials and Methods: All FNAs of cytologically diagnosed STT during 5-year period were retrospectively analyzed. FNAC smears stained using May-Grünwald Giemsa, Pap- and hematoxylin and eosin, were evaluated and interpreted inconjunction with clinical details. Cellblock and immunocytochemistry (ICC) was done, wherever required to render the final diagnosis., Results: Of the total 15,844 FNAC done in 5 years, 1319 (8.3%) cases were diagnosed as STT. Benign tumors comprised the majority (94.2%), whereas 5.8% were diagnosed to be malignant. These were further grouped according to the cytomorphological features into adipocytic (82.2%), benign spindle cell lesions (10.8%), vascular (1.4%), spindle cell sarcoma/sarcoma NOS (2.2%), myxoid (0.3%), round cell tumors (0.9%), metastatic tumors (1.9%), and others (0.3%). The cytological findings were corelated with histopathological findings, which were available in 316 cases. The specificity and sensitivity calculated for detecting malignancy was 99.2% and 95.4%, respectively. The overall diagnostic accuracy for diagnosing malignancy was 98.7%. Among the group of non-adipocytic tumors, the sensitivity, specificity, PPV, NPV calculated for diagnosing a malignant tumor (irrespective of exact sub-categorization) is 95.2%, 100%, 100%, and 96.4%, respectively. The overall diagnostic accuracy in non-adipocytic tumors is 97.92%., Conclusion: FNAC is a simple, cost effective, and minimally invasive method in diagnosing STT with good sensitivity and specificity. It is of utility not only in primary lesions, but also for metastatic tumors, and for the documentation of locally recurrent soft tissue neoplasms., (© 2022 Wiley Periodicals LLC.)

Background: Complete mesocolic excision with central vascular ligation for colonic cancers improves overall survival. To achieve better short term and oncological results, different laparoscopic techniques have been described for right-sided colonic cancers. Laparoscopic right hemicolectomy by the Initial Retrocolic Endoscopic Tunnel Approach (IRETA) is proposed to be easy and offer desired oncological resection; we present our results with IRETA., Patients and Methods: The data of all patients who underwent right hemicolectomy by IRETA for colonic cancer between January 2019 and March 2020 were retrospectively analysed for demographics, clinical features, oncological completeness of resected specimen, complications, hospital stay, morbidity and mortality., Results: A total of eight patients (05 males and 03 females) were identified. The mean operating time was 190 ± 32.40 minutes. Margins of all resected specimens were free of tumour except for one in which retro-peritoneal circumferential resection margin was positive. On average 13.75 ± 2.63 lymph nodes were retrieved. Except for wound infection in one patient, no other morbidity was seen., Conclusion: Laparoscopic radical right hemicolectomy by IRETA is safe and gives desired oncological results., Competing Interests: None

The additive time-series decomposition analysis was performed on National Oceanic and Atmospheric Administration Solar Backscatter Ultraviolet Instrument Merge satellite dataset version 8.6 for the period January 1979 to December 2019 with an objective to detect and apportion long-term trends present in the total ozone column (TOC) and the long-term trends exist in the respective ozone contents present in the vertical sub-columns constituting the TOC viz. upper, middle and lower stratosphere as well as near-surface for the tropical region. Linear regression analysis was performed on the deseasonalized monthly mean time series of TOC and corresponding ozone contents present in each partitioned layer for three different time spans, viz. 1979-2019 (complete time series), 1979-1998 (pre-inflection years), and 1999-2019 (post-inflection years), where 1998 was taken as inflection year. For the complete time-series, statistically significant negative trends were observed in TOC and corresponding ozone contents in the sub-columns over most of the tropical region. Expectedly, during pre-inflection years, strong negative trends were noted for TOC and ozone contents in the partitioned vertical layers. In contrast, during the post-inflection year time span, long-term trends in TOC were statistically insignificant over two-third of the tropical region, but one-third of the subtropical region exhibited negative trends in TOC. During this time span, positive trends were observed in the ozone contents present in the upper stratospheric sub-column. However, negative trends in ozone contents persisted in the middle and the lower stratosphere. It was interesting to note that the ozone contents confined in near-surface layer manifested strong negative trends during pre-inflection years and the same reversed into strong positive trends that in post-inflection span. The observed, contrasting, long-term trends and variability in the respective partitioned layer of the TOC confounded any clear sign of recovery in the TOC over the tropical region. The continuation of declining trends in the middle stratosphere and increasing trends in the near-surface layer of ozone contents is a matter of concern., (© 2022. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

In India, Apophysomyces species complex is the second common agent of mucormycosis mainly affecting immunocompetent hosts unlike other Mucorales. It is frequently involved in causing necrotizing cutaneous infections. The present two-year study was planned to investigate the causative role of Apophysomyces spp. in cutaneous necrotizing infections. The tissue samples were processed using standard techniques and in five out of 65 patients, Apophysomyces variabilis was the etiological agent. Diabetes mellitus and trauma were common risk factors and despite appropriate treatment only one patient could be survived. Apophysomyces variabilis is emerging as agent of necrotizing infections which invariably result in poor patient outcomes., Competing Interests: Declaration of Competing Interest This is to certify that none of the authors has any conflict of interest, financial or otherwise., (Copyright © 2021 SFMM. Published by Elsevier Masson SAS. All rights reserved.)

Background: The use of fine-needle aspiration (FNA) as a primary tool in the diagnosis of breast carcinoma provides opportunity for early proliferative characterization of the tumor. This study was undertaken to assess DNA ploidy and S-phase (SPF) fraction by flow cytometry in fine needle aspirates of patients with breast cancer., Method: Fifty patients of breast cancer diagnosed on fine needle aspiration cytology (FNAC) and who subsequently underwent either mastectomy or lumpectomy were included. Material obtained by FNAC was subjected to DNA ploidy and SPF analysis. Immunohistochemical estimation of Ki-67 was done on histopathology sections. The proliferation markers (SPF and Ki-67) were compared with each other and with the histopathologic parameters., Results: On DNA flow cytometry, 27 (54%) cases were aneuploid and 23 (46%) cases were diploid. The median SPF was 12.43% and 4.03% in aneuploid and diploid tumors respectively. Median Ki-67 among aneuploid tumors was 28.6% compared to 8.7% among diploid tumors. Aneuploid tumors were significantly associated with higher values of SPF and Ki-67, with Kappa 0.437 and agreement of 72%. Diploid tumors showed lower values of SPF and Ki-67, with Kappa 0.455 and agreement of 72.7%. Correlation among SPF and Ki-67 was highly significant with Kappa value 0.446, P value of .002 and agreement of 72.3%., Conclusion: DNA ploidy and proliferative activity by flow cytometric SPF estimation on fine needle aspirates from breast cancer can provide valuable prognostic and predictive information at the time of diagnosis in patients with breast cancer. This might help in selection of appropriate treatment modality., (© 2021 Wiley Periodicals LLC.)

Background: Circulating tumor cells (CTCs) are cells present in the blood stream that are antigenically or genetically similar to a specific tumor type and are markers of tumor diagnosis, prognosis, residual disease and metastasis. The ever-increasing burden of breast cancer globally warrants the incorporation of this all-inclusive marker in the diagnostic repertoire using the simplest of techniques., Aims: To identify CTCs in peripheral blood by cell block (CB) technique in cases of breast cancer diagnosed on fine-needle aspiration (FNA) or core needle biopsy (CNB) and to correlate their presence with nodal metastasis., Material and Methods: This study was conducted in the Department of Pathology, at a tertiary care hospital. Peripheral blood samples from a total of 30 cases of primary breast carcinoma diagnosed on FNA or CNB without prior neoadjuvant chemotherapy were analyzed using the CB technique., Results: The age ranged between 29-74 years with the most common presenting complaint being a palpable, single, unilateral breast lump. CTCs were detected in 2 (6.7%) cases with a <5 cell cluster with both the cases being grade I breast carcinomas and also displaying nodal metastasis., Competing Interests: None

Objective: Phaeohyphomycosis caused by phaeoid fungi is a type of mycosis emerging worldwide which causes a wide variety of clinical manifestations., Study Design: A retrospective analysis of 11 cases diagnosed with fungal inflammation on cytology over a period of 6 years (2013-2018) was done along with culture/histopathologic confirmation., Results: Of the total of 11 cases, 9 cases presented with subcutaneous swellings and 1 case each with brain and lung lesions. The age range was 30-83 years (mean: 53.6); 8 patients were male and 3 were female. Cytologic smears showed fungal profiles with septate tortuous hyphae, as well as swollen and narrow, yeast-like swellings with an irregular breadth of the hyphae in all cases. The fungal profiles were visualized on a Masson-Fontana stain. The background showed inflammatory cells, giant cells, and necrosis in variable proportions. Five cases were diagnosed as phaeohyphomycosis on cytology, whereas 3 cases were misdiagnosed as aspergillus and 2 as candida. In 1 case, typing of the fungus was not done. Histopathology was available in 5 cases, and in all these a diagnosis of phaeohyphomycosis was reached. Ten of the 11 cases had confirmation on fungal culture., Conclusions: Phaeoid fungi are rarely seen in routine cytologic practice. Careful evaluation of cytologic smears and an awareness of the characteristic morphologic features of phaeohyphomycosis are helpful in arriving at a correct diagnosis. Fine needle aspiration cytology provides a rapid diagnosis, enabling prompt therapy., (© 2020 S. Karger AG, Basel.)

Background: Postoperative pancreatic fistula (POPF) or leak from pancreaticojejunostomy (PJ) is one of the most common complications after pancreaticoduodenectomy (PD), with an incidence of 5%-30%. Various techniques have been advocated to bring down the incidence of POPF, but there is still none that can be called the "gold standard". Peng's binding PJ (BPJ) was proposed as a good method of performing PJ with low fistula rates; we present our results with BPJ., Methods: The data of all patients who underwent PD with BPJ between January 2016 and March 2018 were retrospectively analyzed for demographics, clinical features, type of procedure performed, complications (especially POPF), hospital stay, morbidity, and mortality., Results: A total of 24 patients (18 males and 6 females) were identified. The mean age at the diagnosis was 65.5 ± 6.4 years. Majority of the patients had ampullary carcinoma (62.5%). The most common postoperative complication was delayed gastric emptying seen in 10 patients, whereas only 2 (8.33%) had POPF and there was one mortality., Conclusion: BPJ is safe and is associated with a low incidence of POPF., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Nigerian Journal of Surgery.)

Aims: Diabetic foot ulcer is a dreaded complication of diabetes. Diabetic foot ulcer patients are often infected with multidrug resistant organism (MDRO) due to chronic course of the wound, inappropriate antibiotics treatment, frequent hospital admission, neuropathy, nephropathy, and peripheral vascular disease., Materials and Methods: This prospective study was conducted in our 750 bedded hospital for a period of 6 months. The present study was undertaken to isolate various MDRO methicillin resistant Staphylococcus aureus ; Gram-negative bacteria producing enzymes such as extended spectrum beta-lactamases (ESBL), Amp C, Carbapenamases; Pseudomonas and Acinetobacter species producing metallo-beta-lactamases (MBL). In addition we attempted to identify risk factors for association of diabetic foot ulcer and MDRO., Results: A total of 149 bacterial isolates were identified. Of the total isolates 73.2% were Gram-negative and remaining 26.8% were Gram-positive bacteria. Among Enterobacteriaceae 59% were ESBL producers and 48% were Amp C producers. In addition, 41.5% of the isolates produced both ESBL and Amp C and 13.4% were carbapenem resistant Enterobacteriaceae . Among 20 Pseudomonas and Acinetobacter isolates, 5 were MBL producers (25%). Furthermore, in the study, 56% of patients with diabetic foot ulcer harbored MDRO. The risk of multidrug-resistant infection is significantly more in patients having diabetes duration >20 years and size of ulcer more than 4 cm 2 ., Conclusion: The detection of MDRO in patients of diabetic foot ulcer changes the treatment strategies limits the antimicrobial options and causes higher complications among them., Competing Interests: There are no conflicts of interest.

Purpose: The aim is to study the clinical profile and outcome of patients presenting with diabetic foot infections (DFI)., Methods: This was a prospective study recruiting patients >18 years of age, with DFI. All patients underwent a detailed history and clinical examination. Patients were classified as per the International Working Group on the Diabetic Foot -IDSA classification. The patients were followed up every month for 3 months. Clinical outcome was studied regarding the rate of amputations, readmissions, and mortality., Results: There were 65 patients with a mean age of 58.49 ± 11.04 years with male predilection (83.08%). Mean duration of diabetes mellitus was 12.03 ± 6.96 years. Ulcer (92.31%) and discharge (72.31%) were the most common presenting complaints. Monomicrobial growth was present in 36 patients (55.38%). Majority of isolates were Gram-negative (71.43%). The most common isolates were Escherichia coli and Staphylococcus aureus (28.57% each). Mild, moderate, and severe DFI was present in 40%, 47.69%, and 12.31% of patients, respectively. Severe DFI was associated with poor ulcer healing ( P = 0.02) and higher number of major amputations ( P < 0.001). Minor amputations were most commonly associated with moderate and severe DFI. Severe DFI had the highest number of readmissions ( P = 0.04). Patients undergoing minor amputations had a significant association with area of ulcer ( P < 0.001)., Conclusion: This study shows the predominance of monomicrobial growth and Gram-negative organisms in diabetic foot patients. With increase in the severity of DFI, there was increased rate of hospital readmissions, amputations (major and minor), and mortality. Dimensions of ulcer may have a bearing on rate of minor amputations., Competing Interests: There are no conflicts of interest.

Mucormycosis is an emerging opportunistic fungal infection. Increasing immunocompromization, widespread use of antibacterial and antifungal agents (such as voriconazole prophylaxis), carcinomas, transplantation and lifestyle diseases such as diabetes are the main contributors to this situation. The predominant clinical manifestations of mucormycosis vary from host to host, with rhino-orbital-cerebral, pulmonary, cutaneous, and gastrointestinal infections being the most common. In India, the prevalence of mucormycosis is approximately 0.14 cases/1000 population, which is about 70 times the worldwide-estimated rate for mucormycosis. The present study was undertaken over a period of five years (January 2009-December 2014) to determine the prevalence of mucormycosis. The samples suspected of mucormycosis were examined by direct KOH wet mount and cultured on Sabouraud's dextrose agar without actidione and on blood agar as per standard mycological techniques. Histopathological correlation was done for most of the cases. Antifungal susceptibility testing was performed by the EUCAST reference method. We identified a total of 82 cases of mucormycosis out of a total of 6365 samples received for mycological culture and examination during the said time period. Out of these, 56 were male patients and 27 were females. Most common presentation was rhino-orbito-cerebral (37), followed by cutaneous (25), pulmonary (14), oral cavity involvement (4) and gastrointestinal (2). The most common risk factors were diabetes and intramuscular injections. The fungi isolated were Rhizopus arrhizus (17), Apophysomyces variabilis (12), R. microsporus (9), Lichtheimia ramosa (8), Saksenaea erythrospora (5), Syncephalastrum racemosus (4), R. homothallicus (2), Rhizomucor pusillus (1), Mucor irregularis (1) and A. elegans (1). The mainstay of the treatment was amphotericin B, along with extensive surgical debridement whenever feasible. Most of the patients (50) recovered, but 25 died. The rest of the patients left against medical advice. "Nip in the Bud" should be the mantra for clinicians/surgeons for a favorable prognosis. Early diagnosis, prompt institution of appropriate antifungal therapy, surgical debridement whenever necessary, knowledge of risk factors and their timely reversal is the key for management., Competing Interests: The authors declare no conflict of interest.

Carbonaceous aerosols play an important role in affecting human health, radiative forcing, hydrological cycle, and climate change. As our current understanding about the carbonaceous aerosols, the source(s) and process(es) associated with them in the ecologically sensitive North-Western Himalayas are limited; this systematic study was planned to understand inherent dynamics in the mass concentration and source contribution of carbonaceous aerosols in the Dhauladhar region. During four winter months (January 2015-April 2015), 24-h PM 10 samples were collected every week simultaneously at the rural site of Pohara (32.19° N, 76.20° E; 750 m amsl) and the urban location of Dharamshala (32.20° N, 76.32° E; 1350 m amsl). These samples were analyzed by using thermal/optical carbon analyzer for different carbon forms. Organic carbon (OC) dominated over elemental carbon (EC) and was found to be 59.3 and 64.1% in total carbon (TC) at Pohara and Dharamshala, respectively. The respective mass concentrations of OC and EC were higher at Pohara (6.8 ± 2.3 and 4.8 ± 2.0 μg.m -3 ) in comparison to that observed in Dharamshala (5.0 ± 3.1 and 2.5 ± 0.6 μg.m -3 ). The OC/EC ratio at Pohara (1.51 ± 0.41) indicates the dominance of fossil fuel combustion (coal and vehicular exhaust), while at Dharamshala, an OC/EC of 2.01 ± 1.07 signified additional contribution from secondary organic carbon (SOC). Diagnostic ratios (OC/EC and char-EC/soot-EC) suggested dominance of emissions from fossil fuel combustion sources over biomass burning sources in the region. Estimated non-sea salt (nss)K + /OC and nssK + /EC ratios indicated heterogeneity within the biomass burning sources over low and high altitude locations. A strong correlation between nssK + and SOC over a high altitude urban location further suggested possible conversion of gaseous precursors to carbonaceous particles during coniferous wood burning.

Twenty-four hourly samples of total suspended particulate matter (TSPM) were collected once a week over 17 months in the ambient environment of Srinagar (altitude 1524 m), an urban montane location in the North-Western Himalayas. The samples were analyzed to identify and quantify the presence of diverse organic compounds (OCs) using thermal desorption gas chromatography mass spectroscopy (TD-GCMS). Non-polar organic compounds-n-alkanes, polycyclic aromatic hydrocarbons (PAHs), and molecular tracers (retene and nicotine), were detected in the TSPM samples. Molecular diagnostic ratios, derived from the quantified n-alkanes and PAHs in TSPM, assisted in characterization of the contributing sources. Significant variation in the planetary boundary layer height (meters) with change in season (summer to winter) in this region, also, affected the observed variation in the temporal profile of TSPM-bound OCs. TSPM-bound OCs were predominantly contributed from petroleum and biomass combustion; to a lesser extent from biogenic sources. High concentrations of retene and nicotine, known molecular tracers for coniferous wood combustion and tobacco smoke, respectively, were detected in the winter samples. Seasonal variation in TSPM-bound retene corresponded with the periodicity of biomass burning activity in the region. The benzo(a)pyrene equivalent (BAPE) concentrations, a measure for the carcinogenicity of TSPM-bound PAHs was calculated and the value exceeded the prescribed international standards in winter. This finding poses a major health concern for the inhabitants of this region. High BAPE concentration of PAHs during winter was linked to fossil fuel and biomass combustion, where the prevalent meteorology and topography played a synergistic role.

Knowledge of the use of a nasogastric tube (NG) is integral in medical practice as a whole and more so in gastrointestinal diseases because of its wide range of uses. Accidental fixation of the nasogastric tube during surgery is a rare complication. Various methods have been described for retrieval of an entrapped, retained or stapled nasogastric tube. We describe here a novel technique in which an endoscopic needle knife sphincterotome using a side-view endoscope was used successfully to cut the knots and release the entrapped NG tube. Although stress should always be laid on prevention, the flexible endoscopic approach is a small-duration procedure, a minimally invasive, cost-effective technique for the removal of a nasogastric tube that avoids the need of redo surgery and unnecessary exposure to anaesthesia.

An ectopic breast, that is present at a distance from the embryonic milk line, is an uncommon condition in the normal population. We describe a case with the presence of a breast in the dorsal region occurring in a patient with meningomyelocele and split cord malformation type I. A dorsally situated breast in a case of split cord malformation has never been reported previously in the literature. This case report highlights that an ectopic breast could be a marker of occult spinal dysraphism. This lesion should be corrected only after appropriate radiological investigations ascertain the underlying pathology.

Mucormycosis is an emerging angioinvasive infection caused by the ubiquitous filamentous fungi of the Order Mucorales and class of Mucormycetes. We conducted a prospective study of 38 patients who were diagnosed as having mucormycosis in a tertiary care hospital during January 2010 to June 2011. The cases were analyzed regarding the site of involvement, underlying disease and species of fungi isolated, antifungal susceptibility pattern of the isolates, and outcome of therapy. The mean age of the patients was 40.43 years, with 72% male. Rhino-orbital mucormycosis (61.5%) was the most common presentation followed by cutaneous manifestations (31%), gastrointestinal symptoms (5%), and pulmonary (2.5%). Diabetes mellitus (56%) was the significant risk factor in rhino-orbito-cerebral presentation (OR = 7.55, P = 0.001). Among 23 culture isolates, Rhizopus arrhizus (37.5%) was the most common, followed by Apophysomyces variabilis (29.2%), Lichtheimia ramosa (16.7%), Rhizopus microsporus (4.2%), Rhizomucor pusillus (4.2%), and Apophysomyces elegans (4.2%). Rhizopus arrhizus was most commonly isolated from rhino-orbito-cerebral mucormycosis and Apophysomyces species were generally obtained from cutaneous mucormycosis. In vitro antifungal susceptibility showed that 16 isolates were sensitive to amphotericin B (MIC less than 1 μg/ml), while in contrast, all isolates were found to be resistant to voriconazole (MIC- 0.25 to >8), fluconazole (MIC > 32), flucytosine (MIC > 32). Treatment regimens included antifungal therapy, reversal of underlying predisposing risk factors, and surgical debridement. Combination of surgery and medical treatment with amphotericin B was significantly better (OR = 0.2, P < 0.04) than amphotericin B alone (61.5% vs. 10.3% patient survival). The awareness of fungal diseases amongst clinicians is required to decrease the fatal outcome of disease., (© The Author 2015. Published by Oxford University Press on behalf of The International Society for Human and Animal Mycology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: The mucoralean fungi are emerging causative agents of primary cutaneous infections presenting in the form of necrotizing fasciitis., Aims: The aim of this study was to investigate a series of suspected necrotizing fasciitis cases by Apophysomyces species over one-year period in a northern Indian hospital., Methods: The clinical details of those patients suspected to suffer from fungal necrotizing fasciitis were recorded. Skin biopsies from local wounds were microscopically examined and fungal culturing was carried out on standard media. The histopathology was evaluated using conventional methods and special stains. Apophysomyces isolates were identified by their morphology and by molecular sequencing of the internal transcribed spacer (ITS) region of the ribosomal genes. Antifungal susceptibility testing was carried out following EUCAST guidelines and treatment progress was monitored., Results: Seven patients were found to be suffering from necrotizing fasciitis caused by Apophysomyces spp. Six isolates were identified as Apophysomyces variabilis and one as Apophysomyces elegans. Five patients had previously received intramuscular injections in the affected area. Three patients recovered, two died and the other two left treatment against medical advice and are presumed to have died due to their terminal illnesses. Posaconazole and terbinafine were found to be the most active compounds against A. variabilis, while the isolate of A. elegans was resistant to all antifungals tested., Conclusions: Apophysomyces is confirmed as an aggressive fungus able to cause fatal infections. All clinicians, microbiologists and pathologists need to be aware of these emerging mycoses as well as of the risks involved in medical practices, which may provoke serious fungal infections such as those produced by Apophysomyces., (Copyright © 2013 Revista Iberoamericana de Micología. Published by Elsevier Espana. All rights reserved.)

Multidrug-resistant Acinetobacter baumanii is a major pathogen encountered in pyogenic infections, especially from burns patients in hospital settings. Often there is also coexistence of multiple beta-lactamase enzymes responsible for beta-lactam resistance in a single isolate, which further complicates treatment options. We conducted a study on burn wound pus samples obtained from the burns unit of our hospital. Phenotypic tests were used to determine the Extended Spectrum Beta-Lactamase, AmpC Beta-Lactamase and Metallo-Beta-Lactamase producing status of the isolates. Almost half of the samples from the burn wounds yielded Acinetobacter baumanii as the predominant pathogen (54.05%). Coexistence of the three resistance mechanisms was seen in 25 of the 100 (25%) isolates of Acinetobacter baumanii. This study emphasizes the need for the detection of isolates that produce these enzymes to avoid therapeutic failures and nosocomial outbreaks.

Aerosol associated Non-Polar Organic Compounds (NPOCs)--25 n-alkanes, 17 Polycyclic Aromatic Hydrocarbons (PAHs), and 3 Isoprenoid hydrocarbons--have been identified and quantified in PM10 samples collected over four years in time sequence (2006-2009), using Thermal Desorption Gas Chromatography Mass Spectrometry, in Delhi region. Established organic markers, associated diagnostic parameters, and molecular diagnostic ratios were used to assess and discern the contributing biogenic, petrogenic and pyrogenic sources to NPOCs. Analysis show that anthropogenic contributions to NPOCs exhibit increase from 2006 to 2009. Distribution profiles of NPOCs were significantly affected by change in season. Lower concentrations of NPOCs during summer months, and higher during winter, once scaled to Planetary Boundary Layer height, suggests that contributing sources were most active during summer months. During monsoon season high mass fractions of Total n-alkanes (ppm), Total PAHs (ppm), and Black carbon (BC) % alludes at the role of differential washout process involving hydrophilic and hydrophobic fractions of ambient aerosols. Significantly high, four year average concentrations of TPAH and BC signify the dominance of pyrogenic source contributions to PM10. High correlation between monthly mean concentrations of TPAH and BC (R(2)=0.75) suggests that besides common emission source, they are also contributed, individually, by exclusive independent sources., (Copyright © 2013 Elsevier B.V. All rights reserved.)

An attempt has been made to make a comprehensive emission inventory of particulate matter (PM) of various size fractions and also of heavy metals (HMs) emitted from mobile sources (both exhaust and non-exhaust) from the road transport of Delhi, India (1991-2006). COPERT-III and 4 models were mainly used toestimate these emissions. Results show that the annual exhaust emission of PM of size upto 2.5 micrometer (PM2.5) has increased from 3Gg to 4.5Gg during 1991-2006 irrespective of'improvement in vehicle-technology and fuel use. PM emission from exhaust and non-exhaust sources in general has increased. Heavy commercial vehicles-need attention to control particulate emission as it emerged as a predominant source of PM emissions. Among non-exhaust emissions of total suspended particulate matter (TSP), road-surface wear (~49%) has the prime contribution. As a result of-introduction of unleaded gasoline Pb has significantly reduced (~8 fold) whereas share of Cu and Zn are still considerable. Among non-exhaust sources, Pb release was the most significant one from tyre-wear whereas from break-wear, Cu release was found to be the most significant followed by Pb and Cr + Zn. Because of public health concerns further policies need to be developed to reduce emissions of PM and HMs from the road transport of megacity Delhi.

Breast tuberculosis is a rare form of tuberculosis (TB). It is mainly classified as primary and secondary forms. Primary form is rare. We are reporting a case of primary TB breast with history of breast lump and multiple sinuses. TB was diagnosed on FNAC. Patient was put on anti-tubercular drugs.

Background: Traumatic abdominal wall hernia (TAWH) is uncommonly encountered despite the high prevalence of blunt abdominal trauma. The diagnosis is often difficult because of its varied presentation along with lack of awareness of this entity., Methods: The case files of all patients with TAWH who were operated at our hospital were retrospectively reviewed and analyzed., Results: A total of 11 patients with TAWH were analyzed (8 males, 3 females). The clinical presentation was varied, with a palpable defect and a reducible swelling (6 patients), localized area of irreducible swelling (3 patients), surgical emphysema (2 patients), and cellulitis/abscess formation (2 patients). All of these patients were operated within 24 hours of hospital admission. Except for the 3 patients who presented late, there was a favorable outcome in all the others. The cause of mortality was septicemia, possibly due to incarceration of bowel in the defect leading to strangulation and perforation., Conclusion: TAWH, although uncommon, is associated with significant morbidity and mortality when there is a delay in diagnosis and intervention. Early intervention leads to a significantly better outcome.

Localized solitary plasmacytoma of the bone is a rare disease and is characterized by only one or two isolated bone lesions with no evidence of disease dissemination. We report a case of solitary plasmacytoma of the rib in a 43-year-old female. The patient underwent complete en-bloc resection of the chest wall including rib, muscle, and parietal pleura. Patient is asymptomatic without any recurrence after two and half years of follow up.

Objective: We report a rare case of successful surgical management of tubercular tracheal stenosis. There was no history of tracheostomy except for trauma management., Case Report: A 24-year-old man presented with breathing difficulty. He had previously sustained blunt chest injury, a fractured mandible and minor head injury in a traffic accident. Despite successful mandibular fracture fixation, he subsequently developed progressive breathing difficulty with stridor. The patient was treated successfully with surgical resection and bronchoplastic reconstruction. Post-operatively, endotracheal tuberculosis was diagnosed., Conclusion: Endotracheal tuberculosis is rare despite the high incidence of pulmonary tuberculosis in India. Early diagnosis and prompt treatment are necessary to prevent tuberculous tracheobronchial stenosis, an extremely rare but serious clinical problem which can cause obstructive pneumonia and exertional dyspnoea. Surgical resection and bronchoplastic reconstruction is the established treatment for such stenosis. Patients with active tuberculosis usually respond to conventional antitubercular treatment.

Primary hydatid disease of musculoskletal system is rare. A 60 year old woman presented with soft swelling in medial aspect of thigh, of long duration which was gradually increasing in size. She was initially diagnosed as lipoma of thigh, but ultrasonography revealed to be a cystic swelling suggestive of hydatid disease. MRI further reinforced the diagnosis. However serologic test (ELISA) was negative. Patient was given albendazole preoperatively. The swelling was removed en bloc and advised for adjunctive albendazole chemotherapy (15 mg/kg/day) for three months.

Lipomas and lipomatosis of colon are rare in clinical practice. We herein report a case of diffuse colonic lipomatosis, fifth such case in literature which presented as perforation peritonitis, a presentation, never been reported earlier. On laparotomy, the findings suggested malignancy and appropriate surgery was done. Diffuse Colonic Lipomatosis, a rare and benign condition mimicks malignancy and should be kept as a differential diagnosis is unusual cases of colonic perforations.

Primary Hyperparathyroidism is most commonly caused by parathyroid adenoma. Parathyroid adenoma is generally suspected by certain symptoms and biochemical abnormalities. They rarely attain large size to be evident clinically. We report a rare case of giant parathyroid adenoma measuring 5 x 4 x 3 cm and weighing 35 gm.

We are presenting a rare case of bilateral breast cancer. A 65-year-old female reported to us with complaint of lump in the left breast. There was positive family history. The patient was diagnosed with carcinoma breast of left side on edge biopsy and of right side by ultrasonography, which was confirmed on fine needle aspiration cytology. At the time of admission, ultrasonography of the abdomen and right breast were normal. After 1 month, the patient was readmitted with redness over the inner quadrant of the right breast skin.