Subcutaneous Phaeohyphomycosis of Foot in an Immunocompetent Host

We report a case of subcutaneous phaeohyphomycosis of foot, which is a mycotic disease that produces brown pigmented hyphae, pseudohyphae and yeast form in combination. The patient was immunocompetent and had injury 23 years before, and developed a non healing foot ulcer which was clinically suspected as tuberculous or carcinomatous etiology. Local wide excision was done and sent in formalin for histopathological examination. Microscopically pigmented septate, hyphae and yeast forms were identified on hematoxylin and eosin stained sections which were confirmed by special stains such as periodic acid-Schiff and Gomori's methenamine silver stains

Reversal agents: do we need to administer with neuromuscular monitoring – an observational study

Background and Aims: In clinical practice, in the majority of patients, recovery from the effect of muscle relaxants is assessed using subjective methods such as head lift, eye-opening, or by sustained hand grip after giving anticholinesterases (neostigmine) at the end of surgery. We planned a prospective observational cohort study to test the hypothesis that objective neuromuscular monitoring can help us in avoiding the use of anticholinesterases for reversal. Methods: The patients posted for surgery of <2 h duration were included in the study. The cohort of patients was formed on the basis of those who were exposed to objective neuromuscular monitoring of recovery (train-of-four [TOF] ratio of 0.9 or more; exposed group) and the patients who were not exposed to objective neuromuscular monitoring (non-exposed group) acting as a control. Using objective neuromuscular monitoring, the time required for recovery from muscle relaxation when neostigmine was not given for reversal was noted and it was then compared with that of the control group. Results: A total of 190 patients were enrolled over a period of 3 years. With the use of TOF ratio of 0.9 for extubation, patients safely recovered from neuromuscular blockade, without using neostigmine, with no difference in the mean recovery time (14.48 ± 1.138 min) as compared to the control group (12.14 ± 1.067 min, P = 0.139). There was no incidence of reintubation in post-operative period. Conclusion: With objective neuromuscular monitoring, we can ensure complete recovery from the neuromuscular blockade while avoiding the use of anticholinesterases

Exploring the cost-effectiveness of high versus low perioperative fraction of inspired oxygen in the prevention of surgical site infections among abdominal surgery patients in three low- and middle-income countries

Background: This study assessed the potential cost-effectiveness of high (80-100%) vs low (21-35%) fraction of inspired oxygen (FiO2) at preventing surgical site infections (SSIs) after abdominal surgery in Nigeria, India, and South Africa. Methods: Decision-analytic models were constructed using best available evidence sourced from unbundled data of an ongoing pilot trial assessing the effectiveness of high FiO2, published literature, and a cost survey in Nigeria, India, and South Africa. Effectiveness was measured as percentage of SSIs at 30 days after surgery, a healthcare perspective was adopted, and costs were reported in US dollars ($). Results: High FiO2 may be cost-effective (cheaper and effective). In Nigeria, the average cost for high FiO2 was$216 compared with 222 for low FiO2 leading to a -6 (95% confidence interval [CI]:&nbsp;-13 to -1) difference in costs. In India, the average cost for high FiO2 was $184 compared with$195 for low FiO2 leading to a&nbsp;-$11 (95$15 to&nbsp;-$6) difference in costs. In South Africa, the average cost for high FiO2 was$1164 compared with 1257 for low FiO2 leading to a -93 (95% CI:&nbsp;-132 to -65) difference in costs. The high FiO2 arm had few SSIs, 7.33% compared with 8.38% for low FiO2, leading to a&nbsp;-1.05 (95% CI:&nbsp;-1.14 to&nbsp;-0.90) percentage point reduction in SSIs. Conclusion: High FiO2 could be cost-effective at preventing SSIs in the three countries but further data from large clinical trials are required to confirm this