Invasive pulmonary infection by syncephalastrum species: Two case reports and review of literature

Background: Syncephalastrum species belong to the class Zygomycetes and order Mucorale. These are found in the environment and tropical soil, usually presenting as colonizers and rarely cause human infection. Syncephalastrum racemosum is a species of the genus Syncephalastrum and is the most commonly identified pathogen. Most cases are reported in immunocompromised individuals, such as patients on long term steroids, poorly controlled diabetes, or patients with malignancy.Case presentation: We are describing two cases of rare fungal infection by Syncephalastrum species causing invasive pulmonary manifestation. Both patients had compromised immune status and presented with worsening dyspnea to the emergency room. Both had signs and symptoms of bilateral worsening pneumonia evident by chest X-ray showing bilateral pulmonary infiltrates. Syncephalastrum species were isolated from sputum cultures. Deoxycholate amphotericin B was started and the response was monitored. One patient expired while the other improved. Syncephalastrum species belong to class Mucormycosis, rarely causing invasive infection but when they do outcome is potentially fatal. Very few cases are reported worldwide so the clinical course is still unclear. To the best of our knowledge, these are the first two cases to be reported from Pakistan.Conclusions: These two cases describe pneumonia as a result of concomitant infection by rare fungal speciesSyncephalastrum and MRSA in immunocompromised patients. Few cases are reported so limited data is available to understand complete disease implications. Mucormycosis is a therapeutic challenge because of the phylogenetic diversity, un-availability of any serological testing and invasive disease pattern

NEW FORMS OF MODERN GHAZAL

Every genre of literature transforms with time by the means of form and content. Ghazal is the most popular and form-based genre of Urdu Literature. Though very confirmed and defined in its structure and form, Ghazal has also changed its structure and form with time. Especially in the twentieth and twenty-first centuries, when new experiments are being performed particularly with the casting of this ancient kind of literature, Ghazal underwent many transformations in the name of modernity. This article encompasses these changes and modernization of Urdu Ghazal in the contemporary era and near past

Listeria monocytogenes outbreak – serendipity or emerging threat?

Background: Listeria monocytogenes is a facultative, catalase positive, anaerobic, gram-positive bacillus resulting in an infection known as listeriosis. It is one of the many neglected zoonotic diseases. Developing countries with low socio-economic status rely on animals especially cattle for their economy, have higher incidence rates of this disease. The infection spreads via bloodstream causing bacteremia and later may cause serious complications like meningitis. The disease is more common in immune compromised individuals including pregnant females, extremes of ages and those on chemotherapy, and steroids. Listeriosis is markedly under reported hence the true number of affected cases is not known.Material and Methods: We are describing six cases of Listeria monocytogenes infection in a tertiary care hospital in Karachi, Pakistan. Blood cultures and body fluid sample - cerebrospinal fluid were collected from these patients and tested for infection.Results: Out of these six cases, five patients had active bacteremia resulting in positive blood cultures. Two of these five patients had positive cerebrospinal fluid (CSF) for Listeria monocytogenes infection as well. One patient only had CSF polymerase chain reaction (PCR) positive without bacteremia.Conclusions: Few cases of human Listeria monocytogenes infection are reported from Pakistan. In Aga khan University hospital, we identified six cases of Listeria monocytogenes infection in two weeks. We actively managed and studied the clinical course in affected patients. The risk factors were identified and patients were called for follow up. This study emphasizes on the development of prompt measures to prevent future incidences like these by identifying risk factors and disease process

Efficacy and safety of oral GnRh antagonists in patients with uterine fibroids: A systematic review

Objective: This review aimed to assess the efficacy and safety of GnRH antagonists in patients with symptomatic uterine fibroids.Data sources: A literature search was performed on PubMed, Web of Science, Embase, Cochrane, and clinicaltrials.gov using the MeSH and Emtree terms Leiomyoma and Gonadotropin-Releasing Hormone. Study selection: All clinical trials that provided efficacy and safety data in clinical terms (i.e., reduction in menstrual bleeding and discomfort, changes in the size of leiomyoma and uterine volume, etc.) were included. We excluded all preclinical studies, case reports, meta-analyses, review articles, and clinical studies irrelevant to the study question.Data extraction and synthesis: Two authors extracted data from 9 clinical studies. The extracted data included the study\u27s characteristics, participants\u27 baseline characteristics, treatment drugs, efficacy measures, and toxicity.Conclusion: Among oral GnRH antagonists, relugolix, elagolix, and linzagolix were safe in patients with uterine fibroids. These drugs, alone, and in combination with estradiol/norethindrone acetate (E2/NETA), showed significantly better efficacy than placebo in improving bleeding, discomfort, uterine/leiomyoma sizes, and quality of life in premenopausal patients with symptomatic uterine fibroids. However, more randomized double blind multicenter clinical trials are needed to confirm these results and to see long-term benefits