Recurrent breast abscess due to Salmonella paratyphi A:an unusual case

Bacterial mastitis is the most common variety of mastitis and is often caused by Staphylococcus aureus. Chronic mastitis is usually seen as a complication of tuberculosis & syphilis. A 31-year-old female presented with lump in the right breast for the past two years with pain for the past 15 days and discharge for the past two to three days. On examination, the lump was measured and was approximately 4x4 cm in size with a discharging sinus just lateral to the areola. No regional lymphadenopathy was noticed. A clinical diagnosis of “Lump in the right breast” with sinus probably due to tuberculosis was made. The lump had been excised surgically. Salmonella paratyphi A was isolated after repeated culture. She had responded to ceftriaxone, hence, unnecessary use of anti-tubercular drugs could be avoided. In chronic mastitis and breast abscess Salmonella species should be considered as one of the etiological agents.

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

Case Report RHINOORBITAL MUCORMYCOSIS: A CASE REPORT

ABSTRACT In immunocompromised and debilitated patient zygomycosis is the most acute and fulminate fungal infection known. For effective treatment and reduction of morbidity and mortality rate early diagnosis is of utmost importance. Here we report a case of rhinoorbital mucormycosis caused by Rhizopus oryzae in 55 year old diabetic housewife. Microbiological and radiological examination established the diagnosis of rhinoorbital mucormycosis ruling out other differential diagnosis like cavernous sinus thrombosis. Keywords: Rhinoorbital Mucormycosis, Rhizopus Oryzae CASES A 55 year old housewife with 7 years history of diabetes mellitus which was poorly controlled was transferred to our institute from peripheral hospital. Provisional diagnosis was cavernous sinus thrombosis with diabetes mellitus. She gave history of right sided headache since three months. Right sided facial swelling which gradually increased. She was complaining of pain in right eye, difficulty in opening affected eye since two days. On examination patient was having right sided facial swelling, proptosis, and ptosis with lid oedema. Right sided eyeball movements were restricted. Corneal sensation was absent, conjunctival chemosis present. Right eye vision was restricted to finger counting. On fundus examination disc edema, retinal edema with haemorhhages was seen. Right maxillary and frontal sinus tenderness was present. Culture of eye discharge was negative. TLC was 24,900.Random blood sugar level was 368mg/dl. In urine examination no abnormality detected. Patient was negative for HIV antibodies. CT PNS Showed small air fluid levels in bilateral maxillary sinuses. Bony walls of sinuses were normal. Right ostio-meatal unit blocked. Bilateral fronto-ethmoidal recesses blocked. Mildly enhancing soft tissue density lesion was seen in superomedial aspect of right orbit with extension in intraconal and extraconal compartments adjacent to lamina papyreacea (2.4 x 1 cm) Optic nerve appeared bulky. Bilateral cavernous sinus was normal. The subcutaneous soft tissue of medial supraorbital region was swollen. No intracranial extensions were observed in CT scan. On diagnostic nasal endoscopy left nasal cavity was normal. Right side showed black colored mass which was hard and adhered to lateral wall of nose with pus discharge. Material was curette